Patient With Post-COVID-19 Cholangiopathy Undergoes Successful Liver Transplant

By David Douglas

March 25, 2021

NEW YORK (Reuters Health) - A 47-year-old man who recovered from acute respiratory distress syndrome related to COVID-19 and then went on to develop end-stage liver disease is doing well after liver transplantation, according to a new report.

"Liver injury is one of the non-pulmonary manifestations described in COVID-19 infection," said senior author Dr. Johnny C. Hong of the Medical College of Wisconsin, in Milwaukee.

"Post-COVID-19 cholangiopathy, considered a variant of secondary sclerosing cholangitis in critically ill patients, can lead to progressive severe liver injury or failure," he told Reuters Health by email. "When liver failure occurs, liver transplantation is the only definitive life-saving treatment."

In their case report, published in Transplantation Proceedings, Dr. Hong and his colleagues note that their patient was severely obese and had obstructive sleep apnea, hypertension and hyperlipidemia with no prior history of liver disease. He presented with respiratory symptoms of dyspnea, cough, and fever and was subsequently found to be positive for SARS-CoV-2 infection.

The patient went on to experience acute respiratory distress syndrome and acute kidney injury. His pulmonary function subsequently improved and he was weaned off mechanical ventilation after 29 days. However, his acute kidney injury persisted and required regular hemodialysis.

On the 81st day from his initial presentation, he was hospitalized for hypotension during hemodialysis. Further testing showed severe sclerosing cholangitis.

He went on to receive a whole hepatic allograft from a deceased donor. This was performed with intraoperative renal-replacement therapy as well as total peripheral and mesenteric veno-venous bypass.

His hepatic allograft function normalized within eight days after the procedure. At 46 days he went on to recuperation in an acute rehabilitation unit and was subsequently discharged home on the 55th day after the transplant.

At seven months, his allograft function remains normal and he has had no acute cellular or antibody mediated rejection, the authors write. However, the patient still requires dialysis and following a weight loss of 50 kg is now undergoing a comprehensive evaluation for enlistment for renal transplantation.

The researchers conclude that this may be the first such transplantation and stress that "it is important to develop a practical approach in screening and evaluation of patients who are likely to develop post-COVID -19 cholangiopathy, particularly those who will progress to a fulminant course and require an expedited orthotopic liver transplantation."

SOURCE: Transplantation Proceedings, online March 12, 2021.