Mild Course of SARS-CoV-2 Infection in a Liver Transplant Recipient Undergoing Plasma Exchange and Defibrotide for Acute Graft Rejection

Since the beginning of 2020, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread all over the world, and a wide clinical spectrum of coronavirus disease-19 (COVID-19) has also been observed in solid organ transplant recipients, in whom immunosuppressive therapy and comorbidities affect the severity of the infection. We report a case of a 50-year-old woman who underwent liver transplantation for secondary sclerosing cholangitis.Despite the ongoing infection by SARS-CoV-2, the patient received the appropriate immunosuppressive treatment for graft rejection without progression to severe COVID-19. In addition, early beginning of anti-inflammatory, antifibrotic, antithrombotic therapy, and PE might have hampered the development of cytokine storm and endothelial damage despite prolonged high viral replication, thus preventing clinical progression.