Gamma-glutamyltransferase is a strong predictor of secondary sclerosing cholangitis after lung transplantation for COVID-19 ARDS

Schwarz, Štefan; Lang, Christian; Harlander, Matevž; Štupnik, Tomaž; Slambrouck, Jan Van; Ceulemans, Laurens J.; Ius, F.; Gottlieb, Jens; Kuhnert, Stefan; Hecker, Michelle; Aigner, Clemens; Kneidinger, Nikolaus; Verschuuren, Erik; Smits, JM.; Tschernko, Edda; Schaden, Eva; Faybik, Peter; Markstaller, Klaus; Trauner, Michael; Jaksch, Péter; Höetzenecker, Konrad

doi:10.1016/j.healun.2022.06.020

Cited by 6 publications

(2 citation statements)

References 41 publications

(63 reference statements)

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“…Focusing on the monitoring of AST and GGT are important for the screening of severely affected patients at early disease stages. This is consistent with a study that GGT was identified as the most sensitive early parameter in severe COVID-19 patients ( 60 ). In this study, we found that the proportion of patients with a history of CLD was significantly larger in severe cases, and patients with CLD may have elevated liver indicators at baseline.…”

Section: Discussionsupporting

confidence: 93%

Liver injury associated with the severity of COVID-19: A meta-analysis

Yang

Feng

Wan

et al. 2023

Front. Public Health

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BackgroundThe current 2019 novel coronavirus disease (COVID-19) pandemic is a major threat to global health. It is currently uncertain whether and how liver injury affects the severity of COVID-19. Therefore, we conducted a meta-analysis to determine the association between liver injury and the severity of COVID-19.MethodsA systematic search of the PubMed, Embase, and Cochrane Library databases from inception to August 12, 2022, was performed to analyse the reported liver chemistry data for patients diagnosed with COVID-19. The pooled odds ratio (OR), weighted mean difference (WMD) and 95% confidence interval (95% CI) were assessed using a random-effects model. Furthermore, publication bias and sensitivity were analyzed.ResultsForty-six studies with 28,663 patients were included. The pooled WMDs of alanine aminotransferase (WMD = 12.87 U/L, 95% CI: 10.52–15.23, I2 = 99.2%), aspartate aminotransferase (WMD = 13.98 U/L, 95% CI: 12.13–15.83, I2 = 98.2%), gamma-glutamyl transpeptidase (WMD = 20.67 U/L, 95% CI: 14.24–27.10, I2 = 98.8%), total bilirubin (WMD = 2.98 μmol/L, 95% CI: 1.98–3.99, I2 = 99.4%), and prothrombin time (WMD = 0.84 s, 95% CI: 0.46–1.23, I2 = 99.4%) were significantly higher and that of albumin was lower (WMD = −4.52 g/L, 95% CI: −6.28 to −2.75, I2 = 99.9%) in severe cases. Moreover, the pooled OR of mortality was higher in patients with liver injury (OR = 2.72, 95% CI: 1.18–6.27, I2 = 71.6%).ConclusionsHepatocellular injury, liver metabolic, and synthetic function abnormality were observed in severe COVID-19. From a clinical perspective, liver injury has potential as a prognostic biomarker for screening severely affected patients at early disease stages.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, Identifier: CRD42022325206.

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Section: Discussionsupporting

confidence: 93%

Liver injury associated with the severity of COVID-19: A meta-analysis

Yang

Feng

Wan

et al. 2023

Front. Public Health

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“…Previous studies have shown that GGT is the best laboratory indicator of the development of SSC-CIP ( 13 , 43 ). Our results confirmed this.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Features of Post–COVID-19 Cholangiopathy and Its Management Using ERCP

Leonhardt,

Grajecki,

Geisel

et al. 2023

Am J Gastroenterol

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INTRODUCTION: Despite growing awareness of post-COVID-19 cholangiopathy as one of the most serious long-term gastrointestinal consequences of COVID-19, the endoscopic features of this disease are still poorly characterized. This study aimed to more precisely define its endoscopic features and to outline the role of endoscopic retrograde cholangiopancreatography (ERCP) in the management of this entity. METHODS: In this observational study 46 patients with confirmed post-COVID-19 cholangiopathy were included. RESULTS: Based on the endoscopic features observed in 141 ERCP procedures, post-COVID-19 cholangiopathy can be classified as a variant of secondary sclerosing cholangitis in critically ill patients (SSC-CIP). It appeared early in the course of intensive-care treatment of COVID-19 patients (cholestasis onset 4.5 days after intubation, median). This form of cholangiopathy was more destructive than stricturing in nature and caused irreversible damage to the bile ducts. A centripetal pattern of intrahepatic bile duct destruction, the phenomenon of “vanishing bile ducts”, the absence of extrahepatic involvement, and the presence of intraductal biliary casts (85% of patients) were typical cholangiographic features of post-COVID-19 cholangiopathy. This cholangiopathy was often complicated by small peribiliary liver abscesses with isolation of E. faecium and Candida spp. in bile culture. The prognosis was dismal, with a 1-year liver transplant-free survival rate of 44%. In particular, patients with peribiliary liver abscesses or destruction of the central bile ducts tended to have a poor prognosis (n.s). As shown by multivariate analysis, bilirubin levels (on ICU day 25-36) negatively correlated with LT-free survival (HR 1.08, P<0.001). Interventional endoscopy with cast removal had a positive effect on cholestasis parameters (GGT, ALP and bilirubin), approximately 60% of all individual values decreased. DISCUSSION: Gastrointestinal endoscopy makes an important contribution to the management of post-COVID-19 cholangiopathy. ERCP is not only of great diagnostic and prognostic value, but also has therapeutic value and therefore remains indispensable.

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The role of coronary artery disease in lung transplantation: a propensity-matched analysis

Lüsebrink,

Gade,

Seifert

et al. 2024

Clin Res Cardiol

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Background and aims Candidate selection for lung transplantation (LuTx) is pivotal to ensure individual patient benefit as well as optimal donor organ allocation. The impact of coronary artery disease (CAD) on post-transplant outcomes remains controversial. We provide comprehensive data on the relevance of CAD for short- and long-term outcomes following LuTx and identify risk factors for mortality. Methods We retrospectively analyzed all adult patients (≥ 18 years) undergoing primary and isolated LuTx between January 2000 and August 2021 at the LMU University Hospital transplant center. Using 1:1 propensity score matching, 98 corresponding pairs of LuTx patients with and without relevant CAD were identified. Results Among 1,003 patients having undergone LuTx, 104 (10.4%) had relevant CAD at baseline. There were no significant differences in in-hospital mortality (8.2% vs. 8.2%, p > 0.999) as well as overall survival (HR 0.90, 95%CI [0.61, 1.32], p = 0.800) between matched CAD and non-CAD patients. Similarly, cardiovascular events such as myocardial infarction (7.1% CAD vs. 2.0% non-CAD, p = 0.170), revascularization by percutaneous coronary intervention (5.1% vs. 1.0%, p = 0.212), and stroke (2.0% vs. 6.1%, p = 0.279), did not differ statistically between both matched groups. 7.1% in the CAD group and 2.0% in the non-CAD group (p = 0.078) died from cardiovascular causes. Cox regression analysis identified age at transplantation (HR 1.02, 95%CI [1.01, 1.04], p < 0.001), elevated bilirubin (HR 1.33, 95%CI [1.15, 1.54], p < 0.001), obstructive lung disease (HR 1.43, 95%CI [1.01, 2.02], p = 0.041), decreased forced vital capacity (HR 0.99, 95%CI [0.99, 1.00], p = 0.042), necessity of reoperation (HR 3.51, 95%CI [2.97, 4.14], p < 0.001) and early transplantation time (HR 0.97, 95%CI [0.95, 0.99], p = 0.001) as risk factors for all-cause mortality, but not relevant CAD (HR 0.96, 95%CI [0.71, 1.29], p = 0.788). Double lung transplant was associated with lower all-cause mortality (HR 0.65, 95%CI [0.52, 0.80], p < 0.001), but higher in-hospital mortality (OR 2.04, 95%CI [1.04, 4.01], p = 0.039). Conclusion In this cohort, relevant CAD was not associated with worse outcomes and should therefore not be considered a contraindication for LuTx. Nonetheless, cardiovascular events in CAD patients highlight the necessity of control of cardiovascular risk factors and a structured cardiac follow-up.

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Gamma-glutamyltransferase is a strong predictor of secondary sclerosing cholangitis after lung transplantation for COVID-19 ARDS

Cited by 6 publications

References 41 publications

Liver injury associated with the severity of COVID-19: A meta-analysis

Liver injury associated with the severity of COVID-19: A meta-analysis

Endoscopic Features of Post–COVID-19 Cholangiopathy and Its Management Using ERCP

The role of coronary artery disease in lung transplantation: a propensity-matched analysis

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