Should LT be Performed in COVID‐19 Recipients, and Should One Use Organs Procured From COVID‐19 Donors?
AASLD recommends against LT in patients with COVID‐19. LT can proceed 21 days after symptom resolution and negative diagnostic tests in recipients. APASL suggests balancing risks of delaying LT against risks of transmission to health care workers (HCWs). EASL does not specifically address this issue. To minimize the risk to HCWs, APASL recommends LT be performed only in patients with COVID‐19 with at least two consecutive negative SARS‐CoV‐2 nucleic acid results and the presence of antibodies. Finally, there is debate whether immunosuppression should be reduced during the COVID‐19 pandemic. So far there are no data to suggest that posttransplant immunosuppression is a risk factor for severe COVID‐19. In contrast, reducing immunosuppression may increase the risk for graft rejection. All three associations recommend against reducing immunosuppressive therapy in LT patients with mild COVID‐19. The dose of azathioprine, mycophenolate, and calcineurin inhibitor may be reduced in the setting of severe lymphopenia or worsening pulmonary status.