Evaluation of postoperative complications in patients who had liver transplantation at Akdeniz University Faculty of Medicine Hospital during the COVID-19 pandemic

Today, orthotopic liver transplantation is considered the only definitive treatment for patients with end-stage liver disease. Infections are an important problem affecting survival in transplant patients. The pathophysiological mechanisms of how COVID-19-related infection affects the liver are still not clearly known, and the reflection of the COVID-19 infection course in immunosuppressed people and the COVID-19-related pandemic situation on transplant patients is a controversial issue. A total of 81 patients aged 18 and over who underwent liver transplantation between 2018 and 2021, including the COVID-19 pandemic, at Akdeniz University Faculty of Medicine Hospital Organ Transplantation Unit were included in our research. In our study, we aimed to examine the transplant etiology of the patients, their clinical characteristics in the pre- and post-transplant period, and the relationship between the post-transplant complication, rejection and mortality situations and the pandemic period according to the patients' transplantation status before and during the pandemic period. Patient data was accessed using patient files, anesthesia charts and hospital database. Data; It includes the demographic characteristics of the patients, comorbidities, MELD, MELD-Na, CHILD scores, laboratory values, amount of blood and blood products transfused in the intraoperative period, postoperative complications, hospital-intensive care stay duration, rejection and mortality situations. In addition, in our study, the status of patients being infected with COVID-19 in the post-transplant period, the course of infection and infection-related mortality were evaluated by using the hospital database. A total of 81 patients were included in the study, 43 (53.1%) of whom were transferred before the pandemic period and 38 (46.9%) of whom were transferred during the pandemic period. When the etiologies leading to transplantation were examined, it was determined that the most common cause was Hepatitis B virus with 32.1%. In the study, the number of patients who experienced rejection after transplantation was 39 (48.1%) and the number of patients whose transplantation process was mortal was 24 (29.6%). The rejection rate was found to be significantly higher in patients transplanted during the pandemic period (68.4%) than in patients transplanted before the pandemic period (30.2%) (p = 0.001). When the rejection status was examined in the whole group, BMI values were found to be significantly higher in patients with rejection than in patients without (26.14±4.95 and 28.39±4.32; p=0.032). When the conditions associated with mortality were evaluated in the whole group, no significant effect of gender, age, BMI, donor age, Child-Pugh score, MELD score, and ASA score on mortality was found. Donor type was alive in 66.7% of the patients with mortality and cadaver in 33.3%, while 91.2% of the patients without mortality were alive and 8.8% were cadaveric, and these differences were found to be statistically significant (p=0.016). When postoperative complications were evaluated according to the time of transplantation, the rate of pulmonary complications was calculated as 58.1% in patients transplanted before the pandemic period and 92.1% in patients transplanted during the pandemic period, and this difference was determined to be statistically significant (p = 0.001). It was determined that 15 of the patients in the study group were infected with the COVID-19 virus with PCR positivity or CT findings in the postoperative period, and the transplantation process of nine of these 15 patients (60%) resulted in rejection and five of them resulted in mortality. In our study, it was determined that there was a patient who died due to COVID-19 infection. In our study, the duration of hospitalization after the operation was found to be statistically significantly longer in patients transplanted during the pandemic period than in patients transplanted before the pandemic. Additionally, mortality time was found to be significantly shorter in patients transplanted during the pandemic period. When the complications that developed after transplantations during the pandemic period were evaluated, it was determined that the incidence of pneumonia and sepsis was higher in patients transplanted during the pandemic period, but this difference was not statistically significant. In conclusion, the significantly longer length of stay but significantly shorter mortality time in transplant patients during the pandemic period may be associated with the higher number of infections accompanying transplant patients during the pandemic period. Our results were found to be associated with the negative impact of the pandemic period on the clinical course of liver transplant patients. Evaluating factors such as patients' comorbidities, overweight, and treatment compliance by clinicians in the preoperative period and ensuring clinical optimization of patients can contribute positively to transplant success.