First report of auxiliary liver transplantation for severe cholangiopathy after SARS-CoV-2 respiratory infection

Abstract

Post–coronavirus disease 2019 (COVID‐19) cholangiopathy (PCC) is a new entity observed in patients recovering from severe COVID‐19 pneumonia. Most patients recover with cholestasis improving over a period of time. In some patients, cholestasis is severe and persists or progresses to liver failure necessitating liver transplant. We present a previously healthy 50‐year‐old man who developed PCC with peak total bilirubin of 42.4 mg/dl and did not improve with medical management. He underwent living donor auxiliary right lobe liver transplantation. He recovered well after transplant and remains asymptomatic at 6 months follow‐up with good graft function and recovering function in native liver remnant.

Post-COVID-19 Cholangiopathy: A Systematic Review

“…We identified 30 cases of patients with PCC that matched our inclusion criteria. [ 4 , 9 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ] (Table- 1). Most cases described were from the United States of America [ 4 , 9 , 13 , 14 , 15 ].…”

“…Nine patients were evaluated for liver transplant ( Table 1 ). Four of those patients were successfully transplanted [ 9 , 14 , 16 , 19 ] and one expired while on the list [ 13 ].…”

“…A total of 106 cases were identified by our literature search. We extracted information from 28 articles ( Taslble- 1 ) [ 4 , 9 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ] . We collected data on patients’ demographics, symptom onset, liver associated values including initial values and peak values, diagnostic modalities, pathology findings, modes of treatments and overall disease course.…”

“…The most frequent laboratory definition used for a diagnosis of COVID-19 cholangiopathy included: COVID-19-induced cholestasis was defined as a rise in alkaline phosphatase (ALP) by ≥ 1.5 times the upper limit of normal (ULN) with serum bilirubin (≥2 ULN); gamma glutamyl transferase (GGT) (≥3 ULN); absence of active sepsis; and exclusion of other underlying causes of chronic liver disease (8-13). The most common features of severe pulmonary COVID-19 were: respiratory rate >30/minute; dyspnea and/or SpO2 < 90% on room air; and need for mechanical ventilation related to COVID-19 illness; and detectable COVID-19 by polymerase chain reaction (PCR) [ 4 , 9 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ].…”

“…Out of the total 30 cases identified in this review, 14 underwent a liver biopsy as part of their evaluation [ 4 , 9 , 11 , 13 , 14 , 15 , 16 , 19 , 21 ]. The results are summarized in table 4 .…”