SARS-CoV-2 Infection and Pediatric Liver Transplantation: Does It Work?

SARS-CoV-2 infection is an urgent health problem in the world (1). The infection has involved more than 200 countries, and theWorldHealth Organizationhas declared it a pandemic. Coronavirus Disease 2019 (COVID-19) is asymptomatic in most children, making its timely and correct diagnosis difficultinpediatricpatients(2). Thus, children are amajor source of spreading SARS-CoV-2. Liver transplantation is a life-saving procedure, especially in children. However, the effects of SARS-CoV-2 infection are not completely clear on liver transplantation. - What are the clear indications of immediate liver transplantation in children during the COVID-19 epidemic? - What should we do for recipients and donors before liver transplantation during the COVID-19 epidemic? These are now the most challenging issues in the field of transplantation during the COVID-19 epidemic. Our hospital is the second major center of pediatric liver transplantation in Iran. Recently, two boys were excluded from our organ transplantation list because of COVID-19. Thefirstonewas a six-year-oldboywhowas a candidate for liver transplantation due to decompensated cirrhotic Wilson disease. His father was evaluated as a donor, but the chest CT scan was positive for COVID-19. When we examined the recipient, he had no symptoms or signs of COVID-19, but the result of his SARS-COV-2 RNA PCR test was positive. The second case was a 14-year-old boy with idiopathic acute liver failure, who had no findings suggestive of COVID-19. However, his chest CT scan revealed the typical symptoms of COVID-19, and consequently, his SARS-CoV-2 RNA PCR test was positive.