Background: Coronavirus disease 2019 (COVID-19) pandemic has led to deferral of elective transplants and pro-active pre-transplant testing of donor/recipient. The impact of these on living donor liver transplantation (LDLT) activity and outcome is not known. We performed LDLT only for sick or advanced hepatocellular carcinoma (HCC) patients in this period, with special COVID protocols. Methods: Patients undergoing LDLT counseling, evaluation
and transplant in the period March to June 2020 (group A) under COVID-19 restrictions and special protocols were included. LDLT activity and outcomes among these patients was compared to those in the same period in 2019 (group B). Results: In the period March 15-June 10, we performed 39 and 23 (59%) LDLTs in 2019 and 2020 respectively. The adult patients with cirrhosis in-group A (n=20) had significantly higher MELD score, 19.8+/-7.0 versus 16.1+/-5.6 in-group B (n=36), p=0.034. Early recipient mortality was similar in 2019 (2/39) and 2020 (2/23). One out of 23 post-transplant recipients, 3/71 recipients and donors during evaluation, and 8/125 health care workers (HCWs) developed COVID-19, all of whom recovered uneventfully. Conclusion: LDLT activity substantially reduced during the COVID era. The incidence and outcome of COVID-19 among the waiting or transplanted patients and HCWs was similar to the general population. The outcome after LDLT in the COVID era was similar to non-COVID times. These data suggest that LDLT may be extended to more stable patients with strict protocols.