Is Post COVID-19 cholangiopathy an appropriate indication for liver transplantation?

ABSTRACT

The effect of severe acute respiratory syndrome coronavirus-2, which has infected more than 765 million people in the world to date, has decreased gradually, but the effect of late complications after the disease has begun to increase. Post-coronavirus disease 2019 cholangiopathy can be considered as one of the late complications identified in patients recovering from SARS-CoV-2 infection. A 38-year-old man was admitted to our emergency department with fever up to 39,5ºC, dry cough, anosmia, and dyspnea for 4 days. In the chest computed tomography, extensive opacity areas were compatible with multifocal pneumonia. A throat swab confirmed SARS-CoV-2 infection. The patient was treated in the intensive care unit with mechanical ventilator support during 4 weeks. A significant increase in cholestasis enzymes was observed in the patient's control blood. The results of Magnetic Resonance Cholangiopancreatography, Endoscopic Retrograde Cholangio Pancreatography and liver biopsy performed for the etiology of the patient were compatible with post-COVID-19 cholangiopathy. Liver transplantation from a living donor was performed in the patient whose cholangiopathy continued in the first year of follow-up. The patient's clinical course was positive after liver transplantation. It emphasizes that despite the improvement in the lung involvement of COVID-19, the virus can cause long-term liver damage. Liver transplantation may sometimes be required in the treatment of post-COVID-19 cholangiopathy, as in our patient. The persistence of the patient's liver disease for approximately 1 year after Covid-19 and its positive course after liver transplantation show that post-COVID-19 cholangiopathy is a suitable indication for transplantation. The persistence of elevated cholestasis enzymes and bilirubin values after recovery from COVID-19 may help identify patients with post-COVID-19 cholangiopathy in the early period. Early recognition of the occurrence of post-COVID-19 cholangiopathy is important to decide the appropriate course of action.