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In January, doctors of the Medical University of Warsaw performed the first liver transplant in Poland in a patient infected with SARS-CoV-2. The patient did not develop complications related to COVID-19. After 30 days, in good condition, she was discharged from the hospital.
- An 18-year-old female patient required an urgent liver transplant after paracetamol poisoning
- A few hours before the surgery, it turned out that the patient was infected with the SARS-CoV-2 virus. The operation was carried out in full epidemiological protection
- The transplanted liver failed to resume its function. Two days later, another transplant took place – this time it was a success
- You can find more up-to-date information on the TvoiLokony home page
First liver transplant in a patient infected with COVID-19
At the Department and Clinic of General, Transplant and Liver Surgery at the Medical University of Warsaw, headed by prof. dr hab. n. med. Krzysztof Zieniewicz, the first in Poland transplantation and retransplantation of the liver due to super urgent indications in life in an 18-year-old patient after paracetamol poisoning, additionally infected with SARS-CoV-2 virus.
An indication for urgent liver transplantation was a life-threatening condition as a consequence of acute liver failure with features of progressive severe multi-organ failure.
In the Central Clinical Hospital of the University Clinical Center at ul. Banacha 1a in Warsaw, on January 6, 2021, the first group-compatible liver transplant was performed due to the above-mentioned super-urgent indications. A few hours before the operation, as a result of the PCR-RT examination, it turned out that the patient was infected with the SARS-CoV-2 virus. The treatment was carried out in full epidemiological protection, in accordance with the recommendations.
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Second transplant required
On January 8, due to the original failure to take a function (PNF – primary nonfunction) through a transplanted organ, the patient was re-reported to the Organizational and Coordination Center for Transplantation «Poltransplant» as a super urgent recipient. Fortunately, the organ was harvested from the deceased donor in one of the hospitals in Poland in a short time. A second liver transplant was performed immediately.
After this surgery, the patient was treated in the Intensive Surgical Care Department of the Clinic of General, Transplant and Liver Surgery, Central Clinical Hospital of UCK, Medical University of Warsaw, in a full epidemiological regime, by a team led by Dr. Wojciech Figel, MD, PhD. Normal function of the transplanted organ has already been observed with the disappearance of symptoms of multi-organ failure.
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After obtaining a significant clinical improvement, including the return of consciousness, the treatment was continued in the Department of Internal Diseases and Hepatology of the Medical University of Warsaw headed by prof. Piotr Milkiewicz, MD, PhD. No severe respiratory failure was observed throughout the treatment process. The function of the transplanted liver remains normal. In the postoperative period, the PCR-Cov-2 result was converted.
– The different behavior in the case of SARS-CoV-2 infection resulted from the necessity to apply special safety and protection procedures for medical personnel during the entire treatment process. It was particularly difficult to perform precise vascular anastomoses with the use of individual personal protective equipment – says the head of the Department and Clinic of General, Transplant and Liver Surgery, Prof. dr hab. Krzysztof Zieniewicz, MD, PhD.
An additional difficulty was the need to ensure the isolation of the patient and close monitoring of the course of SARS-Cov-2 infection in the context of immunosuppressive treatment. The whole situation required an exceptional commitment not only from the medical team, but above all from the nursing team – adds prof. Zieniewicz.
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A special role in the treatment of the patient was played by the surgeons-transplantologists: dr hab. Krzysztof Dudek, Dr. Konrad Kobryń, Dr. Michał Skalski, Dr. Jan Stypułkowski and anesthesiologists: Dr. Marta Dec and Dr. Anna Brudkowska. Extracorporeal venous circulation was conducted by Krzysztof Zając, MA. The instrumentalists were: Anna Wąsik, Joanna Stasiak, Grzegorz Nowakowski, and the anesthesiology nurses: Barbara Struś, Agata Małek and the anesthesiology nurse Piotr Wesołowski.
The professionalism and great contribution of the nursing team of the Intensive Surgical Therapy Department of the General, Transplant and Liver Surgery and the team of rehabilitators should be appreciated and emphasized.
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The patient in a very good general condition, on the 30th day after the first transplantation, returned home to the care of her parents. She is systematically inspected on an outpatient basis at the Clinic’s Transplant Clinic.
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