Table 1.
Details of the three cases reported
| Case 1 | Case 2 | Case 3 | |
| Age (yr) | 61 | 68 | 62 |
| Sex | Female | Male | Female |
| LT indication | Cryptogenic cirrhosis | NASH | Primary biliary cholangitis |
| Date of liver transplant | September 7, 2019 | March 3, 2020 | February 13, 2019 |
| Immunosuppression (per day) | Tacrolimus 5 mg and prednisone 5 mg | Tacrolimus 7 mg, mycophenolic acid 2000 mg, prednisone 20 mg | Tacrolimus 3 mg, mycophenolic acid 2000 mg, prednisone 5 mg |
| Blood concentration of tacrolimus (before COVID-19) | 7 ng/mL | 7.5 ng/mL | 5.2 ng/mL |
| Allograft function (before COVID-19) | Normal | Normal | Increased GGT and ALP |
| Comorbidities | Hypothyroidism | Diabetes, hypertension, stroke | Hypertension |
| Laboratory test1: | |||
| PaO2: FiO2 ratio (while IMV) | 237 (76-376) | 367 (337-385) | 256 (133-329) |
| White-cell count (× 103/UL) | 4.50 (2.38-9.87) | 6.61 (1.8-17.4) | 15.71 (7.02-36.14) |
| Lymphocyte count (× 103/UL) | 0.30 (0-0.65) | 0.325 (0.2-1.02) | 1 (0.54-2.01) |
| Platelet count (× 103/UL) | 9.5 (3-38) | 113.5 (37-372) | 290 (158-406) |
| Hemoglobin (g/DL) | 8.7 (6.5-9.4) | 9.2 (7-11.8) | 10.4 (7.6-12.9) |
| Il-6 (pg/mL) | 599 (400-799) | 558 (192-1000) | 54 (50-286) |
| C-reactive protein (mg/DL) | 10.3 (8.2-18.3) | 4 (0.4-13.3) | 1.8 (0.7-4.6) |
| Procalcitonin (ng/mL) | 2.2 (1.1-7.8) | 0.25 (0.12-0.43) | 0.28 (0.17-0.75) |
| Ferritin (ng/mL) | 5338 (814-9862) | 1262 (392-2095) | 2047 (1360-2297) |
| Lactate dehydrogenase (U/L) | 452 (209-649) | 265 (161-378) | 399 (165-646) |
| Aspartate aminotransferase (U/L) | 126 (29-466) | 14 (9-36) | 30 (16-44) |
| Alanine aminotransferase (U/L) | 89 (29-197) | 21 (8-31) | 24 (5-98) |
| Total bilirubin (mg/DL) | 1.2 (0.3-2.65) | 0.56 (0.39-1.23) | 1.82 (0.21-4) |
| Creatine kinase (U/L) | 14 (10-18) | 13 (7-75) | 29 (29-36) |
| Creatinine (mg/DL) | 0.69 (0.45-1.07) | 1.22 (1.04-1.93) | 0.89 (0.54-2.65) |
| D-dimer (ng/mL) | 1073 (565-1825) | 1347 (620 - 3431) | 283 (153-648) |
| Sodium (meq/L) | 137 (128-141) | 139 (136 - 163) | 141 (135-145) |
| Potassium (meq/L) | 4.6 (2.9-5.8) | 4 (3.3-4.9) | 4 (3.2-5.2) |
| Chloride (meq/L) | 102 (97-105) | 103 (100-111) | 107 (99-112) |
| RT-PCR of SARS-CoV-2 | Negative on day 3; positive on day 6 | Negative on day 8; positive on days 13, 36, 42, 47, 54, 65 and 79 | Negative on days 14, 72 and 75; positive on days 26, 42 and 55 |
| Radiologic findings | Bilateral pneumonia, pleural effusion | Bilateral pneumonia, peripheral ground-glass opacity, pleural effusion | Bilateral pneumonia, peripheral ground-glass opacity |
| Treatment | HCQ (200 mg daily), azithromycin (250 mg daily), LPV/r (one dose 400/100 mg), vancomycin (1 g daily) | HCQ (200 mg daily), azithromycin (250 mg daily), tocilizumab (one dose 8 mg/kg), methylprednisolone (180 mg three doses) | HCQ (200 mg daily), azithromycin (250 mg daily), tocilizumab (one dose 8 mg/kg), methylprednisolone (60 mg daily), vv-ECMO |
| Immunosuppressant dose reduction | Yes (low dose of tacrolimus) | Yes (mycophenolic acid suspended and low dose of tacrolimus) | Yes (mycophenolic acid suspended) |
| Rejection during or after COVID-19 | No | No | Yes |
| Complications | Secondary Enterococcus faecalis (BAL culture) lung infection | Asymptomatic intra-abdominal collection | Tracheoesophageal fistula |
1
Expressed as the median and range, of the analytical values since the RT-PCR of SARS-CoV-2 was positive until present. ALP: Alkaline phosphatase; BAL: Bronchoalveolar lavage; GGT: Gamma-glutamyltransferase; HCQ: Hydroxychloroquine; ICU: Intensive care unit; IMV: Invasive mechanical ventilation; LPV/r: Lopinavir/ritonavir; NASH: Non-alcoholic steatohepatitis; NE: Norepinephrine; RT-PCR: Reverse transcription polymerase chain reaction; vv-ECMO: Venovenous extracorporeal membrane oxygenation.