Liver transplantation in patients with SARS-CoV-2: Two case reports

BACKGROUND

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19). This disease was declared a worldwide health problem with the characteristics of a pandemic. Most patients have mild symptoms and a good prognosis. Information on the evolution and prognosis of COVID-19 in solid organ recipients is scarce.

CASE SUMMARY

We describe two patients who underwent liver transplantation with a positive test result for detection of the viral sequence for COVID-19, using reverse-transcription polymerase chain reaction (RT-PCR), immediately before transplantation. The patients showed good evolution in the postoperative period, without signs of graft dysfunction. The immunosuppressive therapy was not modified. Both patients were discharged for subsequent outpatient follow-up.

CONCLUSION

In conclusion, it is expected that the experience at this center can be used as an example, aimed at the continuation of transplantations by other services and, thus, the morbidity and mortality of patients with liver disease on the transplantation waiting list can be reduced. Transplant centers must be able to readjust daily to the evolution of the COVID-19 pandemic.

Clinical assessment and pathophysiology of Bothrops venom-related acute kidney injury: a scoping review

Bothrops are one of the most common medically important snakes found in Latin America. Its venom is predominantly hemotoxic and proteolytic, which means that local lesion (edema and redness) and hemorrhagic symptoms are recurrent in envenoming by this snake. Although hemorrhage is usually the major cause of death, snakebite-related acute kidney injury is another potentially fatal clinical complication that may lead to chronic kidney disease. The present review highlights the main studies on Bothrops venom-related acute kidney injury, including observational, cross-sectional, case-control and cohort human studies available up to December 2019. The following descriptors were used according to Medical Subject Headings (MeSH): on Medline/Pubmed and Google Scholar "acute kidney injury" or "kidney disease" and "Bothrops"; on Lilacs and SciELO "kidney disease" or "acute kidney injury" and "Bothrops". Newcastle-Ottawa quality assessment scale was used to appraise the quality of the cross-sectional and cohort studies included. The selection of more severe patients who looked for health care units and tertiary centers is a risk of bias. Due to the methodological heterogeneity of the studies, a critical analysis of the results was performed based on the hypothesis that the design of the included studies influences the incidence of acute kidney injury. Fifteen human studies (total participants 4624) were included according to stablished criteria. The coagulation abnormalities (hemorrhagic symptoms, abnormal fibrinogen and activated partial thromboplastin time) were associated with acute kidney injury in the most recent studies reported. The findings observed in this review provide up-to-date evidence about the acute kidney injury pathogenesis following Bothrops syndrome. Studies pointed out that coagulation abnormalities comprise the major pathway for acute kidney injury development. This review may improve patient management by primary healthcare providers, allowing earlier diagnosis and treatment of Bothrops venom-related acute kidney injury.