Versorgung von Lebertransplantierten während der COVID-19-Pandemie: Update der S1-Leitlinie

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic continues to be a challenge for the entire health care system, including the care of liver transplant recipients, who represent a vulnerable population. OBJECTIVES: The aim of this work is to provide a practice-oriented review of the updated S1 guideline on the care of liver transplant recipients during the COVID-19 pandemic. MATERIALS AND METHODS: We summarize the updated guideline (as of 15 June 2022) issued by DGVS (“Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten”) and DGAV (“Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie”). RESULTS: Liver transplantation programs including evaluation, organ donation, and follow-up should continue during the pandemic, as they represent a life-saving therapeutic option. However, adjustments are possible depending on the pandemic situation. Vaccinations against severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) should be carried out according to the STIKO (“Ständigen Impfkomission”) recommendations, and antibody testing is useful. In case of infection, various therapeutic options are available. Generally, pre-emptive adjustment of immunosuppression due to the pandemic is not recommended, but adjustment of regimens containing mycophenolate mofetil, particularly in case of SARS-CoV‑2 infection, may be reasonable. CONCLUSIONS: Both immunization and the now available antiviral/immunomodulatory therapy improve prevention and treatment of COVID-19 in liver transplant recipients. Early detection through rigorous testing is of paramount. The improved pharmacological options also allow transplantation of positive donors or recipients under careful consideration.