Background : Solid organ transplantation recipients could be at a higher risk for SARS-CoV infection than non-transplantation population and have more poor outcomes than non-infected recipients.

Methods : We report our experience with adult-to-adult living donor liver transplantation(LDLT) recipient with SARS-CoV infection.

Results : A 49 year old female patient with alcoholic liver cirrhosis underwent LDLT on 28th Oct, 2023. The recipient had hepato-renal syndrome prior to LDLT and continuous renal replace therapy(CRRT) was necessary for 2 weeks postperatively. The COVID-19-specific real-time polymerase chain reaction (RT-PCR) test of the recipient turned out positive during operation even the same test of donor was negative. We decided to reduce immunosuppressant dose and not to use antiviral agent for renal and graft protection from toxic agent. Basiliximab was used as induction therapy. We tried to keep the trough serum level of FK506 around 8ng/mL with 750mg of Mycophenolate mofetil twice a day. Methylprednisolone was tapered from 500mg to 5mg a day by postoperative 1 month. Initial postoperative serum total bilirubin level was 5.5mg/dL and it gradually decreased to the reference range and so was serum aminotransferases level. Serum C-reactive protein(CRP) level went up to 13.2mg/dL and then decreased to 3.7mg/dL by discharge day. The recipient never had fever until discharge and there was no evidence of viral pneumonia on radiologic chest image. The patient was discharged on postoperative 1 month.

Conclusions : From this experience, the regimen for COVID-19 positive LT recipients should be selected very carefully according to the infection level, each organ function, immune status and possible side effects.