Post-COVID-19 Cholangiopathy: A Systematic Review

Yanny, Beshoy; Alkhero, Mohammed; Alani, Mohammed M.; Stenberg, Daniel; Saharan, Aryan; Saab, Sammy

doi:10.1016/j.jceh.2022.10.009

Cited by 18 publications

(31 citation statements)

References 43 publications

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“…Regarding the risk factors, some studies described male gender and metabolic syndrome, including hypertension and diabetes, as potential risk factors for post-COVID-19 cholangiopathy. 9,19,20 In our series, most patients were male and had a history of hypertension and diabetes, which supports the previous findings. Therefore, patients with these high-risk features (male, history of metabolic syndrome, and ARDS due to severe COVID-19 infection requiring ICU admission) should be closely monitored for evidence of cholangiopathy, even after recovery from the initial COVID-19 infection.…”

Section: Discussionsupporting

confidence: 92%

“…In our series, most patients were male and had a history of hypertension and diabetes, which supports the previous findings. Therefore, patients with these high‐risk features (male, history of metabolic syndrome, and ARDS due to severe COVID‐19 infection requiring ICU admission) should be closely monitored for evidence of cholangiopathy, even after recovery from the initial COVID‐19 infection 9 …”

Section: Discussionmentioning

confidence: 99%

“…9 Although the majority of previously reported patients were treated with UDCA 9 and some were provided plasma exchange 16 or ERCP, 12 the treatment effect was limited. 9 The reported mortality rate of post-COVID-19 cholangiopathy is 23.3%, 9 and LT appears to be the only curative treatment at this moment. 27 LT as a treatment for SSC-CIP has been described in the literature.…”

Section: Discussionmentioning

confidence: 99%

“…More recently, cholestatic liver injury (elevation of alkaline phosphatase [ALP], gamma‐glutamyl transferase [GGT], and bilirubin), which appears in the later stages of severe COVID‐19 infection, has been described. This novel entity is known as post‐COVID‐19 cholangiopathy 7–11 . According to the editorial by Heucke et al 3 .…”

Section: Introductionmentioning

confidence: 99%

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Liver transplantation for post‐COVID‐19 cholangiopathy: A case series

Sambommatsu,

Mouch,

Kulkarni

et al. 2023

Clinical Transplantation

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BackgroundPost‐COVID‐19 cholangiopathy is an emerging cholestatic liver disease observed in patients recovering from severe COVID‐19 infection. Its prognosis is poor, necessitating liver transplantation in some cases. This study aimed to investigate the outcomes of liver transplantation for post‐COVID‐19 cholangiopathy.MethodsSeven patients who underwent liver transplantation for post‐COVID‐19 cholangiopathy at three institutions between 2020 and 2022 were included in this retrospective multi‐center case series.ResultsAt the time of initial COVID‐19 infection, all patients developed acute respiratory distress syndrome, and six patients (86%) required ICU admission. Median time intervals from the initial COVID‐19 diagnosis to the diagnosis of post‐COVID‐19 cholangiopathy and liver transplantation were 4 and 12 months, respectively. Four patients underwent living donor liver transplantation, and three patients underwent deceased donor liver transplantation. The median MELD score was 22 (range, 10–38). No significant intraoperative complications were observed. The median ICU and hospital stays were 2.5 and 12.5 days, respectively. One patient died due to respiratory failure 5 months after liver transplantation. Currently, the patient and graft survival rate is 86% at a median follow‐up of 11 months.ConclusionsLiver transplantation is a viable option for patients with post‐COVID‐19 cholangiopathy with acceptable outcome. Timely identification of this disease and appropriate management, including evaluation for liver transplantation, are essential.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Liver transplantation for post‐COVID‐19 cholangiopathy: A case series

Sambommatsu,

Mouch,

Kulkarni

et al. 2023

Clinical Transplantation

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“…Moreover, drugs used in COVID-19 patients, such as tocilizumab and baricitinib, are able to lead to hepatitis-B-virus (HBV) reactivation with liver derangement [ 41 ]. On the other hand, it is a field of debate on the role and impact of SARS-CoV-2 infection on cholestasis worsening in cholestatic disease (e.g., primary biliary cholangiopathies, sclerosing cholangitis) patients [ 42 ] ( Figure 2 ).…”

Section: Resultsmentioning

confidence: 99%

Liver Damage and COVID-19: At Least a “Two-Hit” Story in Systematic Review

Montori

Baroni

Santori³

et al. 2023

CIMB

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COVID-19 pandemic waves have hit on our lives with pulmonary and, also, gastrointestinal symptoms. The latter also includes acute liver damage linked to direct SARS-CoV-2 action and/or drug-induced (DILI) in the frame of pre-existing chronic liver disease. We aimed to review literature data regarding liver damage during COVID-19. We conducted a systematic search on the main medical databases for original articles, reviews, meta-analyses, randomized clinical trials and case series using the following keywords and acronyms and their associations: liver disease, COVID-19, acute liver damage, drug-induced liver injury, antivirals. Acute liver damage due to SARS-CoV-2 infection is common among COVID-19 patients and is generally self-limiting. However, chronic hepatic diseases, such as metabolic-associated fatty liver disease (MAFLD), are associated with a less favorable prognosis, especially when alkaline phosphatases show a significant rise. Pathophysiology of COVID-19 liver damage is multifaceted and helps understand differences in liver derangement among patients. Thus, early recognition, monitoring and treatment of liver damage are crucial in these patients. In the frame of a not-ending pandemic sustained by SARS-CoV-2, it is crucial to recognize acute hepatic decompensation due to the virus and/or drugs used for COVID-19 treatment.

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