The indication for urgent liver transplantation was immediate life-threatening condition due to the acute liver failure accompanied by severe multi-organ failure.
On January 6, 2021, at the Central Clinical Hospital of the University Clinical Center, 1a Banacha Street, Warsaw, the first group-compatible liver transplantation was performed for the super urgent indications listed above. Several hours before surgery began, a PCR-RT test revealed that the patient was infected with SARS-CoV-2 virus. Therefore, the procedure was performed under full epidemiological protection, according to the recommendations.
On January 8, 2021, due to the primary nonfunction (PNF) of the transplanted organ, the patient was again reported to the Transplant Coordinating Center Poltransplant as a super-urgent recipient. Fortunately, in a short time they were able to retrieve an organ from a deceased donor at one of the hospitals in Poland. A second liver transplant was performed immediately.
After this procedure, the patient was managed by a team led by Wojciech Figel, MD, PhD in the Surgical Intensive Care Unit of the Department and Clinic of General, Transplant and Liver Surgery at the UCC MUW, under full epidemiological regime. Normal function of the transplanted organ was already observed and the symptoms of multiple organ failure resolved.
After significant clinical improvement, including the return of consciousness, the treatment was continued in the Department of Hepatology of the Medical University of Warsaw, headed by Professor Piotr Milkiewicz, MD, PhD. No severe respiratory failure was observed during the entire healing process. The function of the transplanted liver remains normal. There was a conversion of the PCR-Cov-2 result in the postoperative period.
“The different management in case of SARS-CoV-2 virus infection resulted from the need for special safety and protection procedures for medical personnel throughout the treatment process. It was particularly challenging to perform precise vascular anastomoses with individual personal protective equipment. An additional difficulty was the need to ensure patient isolation and close monitoring of SARS-Cov-2 infection in the context of immunosuppressive therapy. The whole situation required exceptional commitment not only from the medical team, but more importantly from the nursing team." - says the Head of the Department and Clinic of General, Transplant and Liver Surgery, Professor Krzysztof Zieniewicz.
The following surgeons-transplantologists played a special role in the treatment of the patient: Krzysztof Dudek, MD, PhD, Konrad Kobryń, MD, Michał Skalski, MD, PhD, Jan Stypułkowski, MD, and anesthesiologists: Marta Dec, MD, and Anna Brudkowska, MD. The extracorporeal venous circulation was performed by Krzysztof Zając, M.D. The instrumentalists were Anna Wąsik, Joanna Stasiak, and Grzegorz Nowakowski, and the anesthesia nurses were: Barbara Struś, Agata Małek, and nurse anesthetist Piotr Wesołowski. The professionalism and great contribution of the nursing team of the Surgical Intensive Care Unit of the Department and Clinic of General, Transplant and Liver Surgery and the rehabilitation team should be appreciated and emphasized.
The patient returned home to her parents' care on day 30 after the first transplant in a very good general condition. She is systematically followed up on an outpatient basis at the Transplantation Outpatient Clinic.
