Liver transplantation for post-COVID-19 sclerosing cholangitis

Area of Science:

• Hepatology
• Infectious Diseases
• Transplantation

Background:

• COVID-19, initially recognized as a respiratory illness, has demonstrated multi-organ involvement.
• The specific impact of SARS-CoV-2 infection on liver function and biliary system remains incompletely elucidated.
• Understanding post-COVID-19 hepatic sequelae is crucial for patient management.

Observation:

• A 64-year-old male with no prior liver or respiratory conditions developed severe COVID-19 pneumonia requiring mechanical ventilation.
• Months post-respiratory recovery, the patient presented with jaundice, elevated liver enzymes (transaminitis), abdominal pain, and dark urine.
• Progressive hepatic dysfunction necessitated deceased donor liver transplantation (LT).

Findings:

• Explant liver pathology revealed diffuse hepatic injury, characteristic "onion skinning" of bile ducts, and bile duct loss within portal tracts.
• The patient's liver disease progressed to end-stage cholangiopathy, directly linked to the preceding COVID-19 infection.
• Successful LT was performed 259 days after the initial COVID-19 diagnosis.

Implications:

• This case suggests a potential causal link between COVID-19 and the development of end-stage liver disease, specifically cholangiopathy.
• Liver transplantation (LT) should be considered as a therapeutic option for patients experiencing severe, COVID-19-induced liver damage.
• Further research is warranted to understand the mechanisms of COVID-19-related hepatobiliary injury and long-term outcomes post-transplantation.