ICMR drafts treatment protocol for liver transplant patients amid COVID-19 crisis

In the view of rapidly changing scenario of coronavirus (COVID-19) infection in the country, the Indian Council of Medical Research (ICMR) has issued a guideline for liver transplant patients.

As Immunocompromised patients are at greater risk, hence, there is an immediate need of guidelines for liver transplantation patients in India, both at Deceased Donor Liver Transplant (DDLT) and Living Donor Liver Transplant (LDLT) centres, said ICMR official.

ICMR has stated as healthcare transmissions of Covid-19 has occurred and given the potential for greater infectivity strict isolation should be followed for anyone suspected with coronavirus.

Around 10 lakh patients of liver complications are diagnosed every year in India. Liver disease is the tenth most common cause of death in India, as per the World Health Organization (WHO).

"People with acute liver failure and acute chronic liver failure should not be denied transplant procedures. They can be operated after having the COVID-19 screening done. Also, during transplant, blood transmission is needed, so blood samples should also be investigated against COVID-19," Dr Shiv Sarin from ILBS hospital told ANI.

People with comorbidity and immunocompromised are more vulnerable so they need extra care, he said.

According to the guidelines for issues specific to liver transplant, a moratorium of all non-urgent transplants for two weeks should be done.

"In case of acute liver failure can be done as usual after medical therapy has failed and Acute on chronic liver failure should be based on individual's Centre's discretion," the guidelines said.

For deceased Donor Liver Transplant - Elective (DDLT) should be done only in the donor is coronavirus negative (Both RT-PCR and serological test negative, it said.

"Living Donor Liver Transplant (LDLT) should be done for urgent cases after the counselling as LDLT imposes a risk on the healthy Donor with the hospital admission and contact risks," mentioned the guidelines adding that COVID-19 testing if donors and recipients should be done at the time of urgent transplant.

The apex medical research body has mentioned that standard Immunosuppression strategy should be followed. "No evidence exists as of now to modify immunosuppression due to COVID-19," the guidelines said.

For follow up of a post-transplant, a patient should be followed up with their respective centre as usual.

"All routine follow-up visits to be done online via telemedicine, however, those patients with post-transplant emergencies should attend hospital as usual," the guidelines said.

Care of sick recipients on the waitlist the management of recipients for various medical complications to be continued the hospital including ICU admissions, it noted.

Prophylactic medications for coronavirus at present there is no recommendation for prophylactic medications or vaccinations for transplant patients.

Also, testing of transplant professionals should be done selectively if there has been a positive case of coronavirus in the concerned hospital.

Till date, India has detected over 900 cases of covid19 and 19 deaths.