There is a concern that immunocompromised patients are at a greater risk of morbidity and mortality due to COVID-19 infection, although data on liver transplant patients is limited at present . It is anticipated that transplant recipients may have a greater viral burden and shedding resulting in greater infectivity and potential spread to other individuals, including healthcare workers. There is a risk of donor to recipient transmission of COVID-19, both from deceased donors and living donors. The risk of donor-derived infection would depend upon donor exposure, infectivity in the incubation period, degree and duration of viremia, and viability of the virus within blood or specific organ compartments .
COVID-19 virus can remain viable and infectious in aerosols for hours and on surfaces up to days (depending on the inoculum shed) . This raises the concern of nosocomial spread and superspreading events. In addition, patient-to-patient and patient-to-healthcare worker infection have been described. Whether COVID-19 can be transmitted parenterally is not known, nevertheless, screening of all blood donors should be done. Preventing transmission from an infected patient to a healthcare worker and vice versa is of great importance. Current recommendations are for both droplet and airborne precautions for infection control in the hospital setting. In general, for the society emphasis should be given on recommended preventive measures against COVID-19 namely social distancing, frequent hand washing, cleaning frequently touched surfaces, following cough etiquettes, etc.
The impact of immunosuppression in the post-transplant setting is currently not known and further data is needed before any specific recommendation can be made. It is expected that due to immunosuppression post-transplant, infected patients may have more intense and prolonged shedding of virus. This will also increase the risk of viral transmission among healthcare workers. Antivirals for COVID-19 will be available in very near future, and drug–drug interactions with immunosuppressive medications will also need to be considered.