Background : The coronavirus disease 2019 (COVID-19) pandemic has had a major global impact on liver transplantation (LT) and living donor program. In this study, we aimed to present the principles and strategies of our LT program in 2021 during the pandemic period and describe its achievements.

Methods : We retrospectively reviewed the outcomes of 468 LTs performed at Asan Medical Center, Seoul, Korea, during the year 2021. Of these, excluding 68 recipients donated from deceased donor, 400 recipients underwent LT from 417 live donors, of which 11 recipients were children under 18 years of age.

Results : Among 400 LDLT recipients, the most common indication of LT was hepatitis B virus (188/389, 48.3%) in adult, whereas biliary atresia (4/11, 36.4%) in pediatric recipients. Emergency LDLT was performed in 11 patients (2.8%). The median model of end-stage liver disease and pediatric end-stage liver disease score were 13.33±6.68 and 11.27±7.34, respectively. In-hospital mortality of recipients was higher than usual at 3.0%, but the cause of death was not related to COVID-19 infection. Of the 417 live donors who underwent hepatectomy for liver donation during the same period, 221 (60.0%) underwent hepatectomy using a minimally invasive approach. Although 6 (1.4%) live donors experienced major complications, there were no serious life-threatening complications and no mortalities.

Conclusions : This study shows that even in the pandemic era, a team with well-established infection control protocols, patient-tailored surgical strategies, and thorough perioperative care can maintain LDLT at a similar quantitative and qualitative level as in the non-pandemic era.