COVID-19-associated secondary sclerosing cholangitis with liver transplantation

Anne Kristin Fischer; Dirk Stippel; Ali Canbay; Dirk Nierhoff; Michael Thomas; Jan Best; Reinhard Büttner; Uta Drebber

doi:10.1007/s00428-024-03753-4

COVID-19-associated secondary sclerosing cholangitis with liver transplantation

Virchows Arch. 2024 Mar 25. doi: 10.1007/s00428-024-03753-4. Online ahead of print.

Authors

Anne Kristin Fischer¹, Dirk Stippel², Ali Canbay³, Dirk Nierhoff⁴, Michael Thomas², Jan Best³, Reinhard Büttner⁵, Uta Drebber⁵

Affiliations

¹ Institute of Pathology, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany. Anne.Kristin.Fischer@uk-koeln.de.
² Department of Surgery, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
³ Department of Internal Medicine, Transplant Medicine, Gastroenterology and Hepatology, University of Bochum, In Der Schornau 23-25 44892, Bochum, Germany.
⁴ Department of Internal Medicine, Gastroenterology and Hepatology, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
⁵ Institute of Pathology, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.

PMID: 38526652
DOI: 10.1007/s00428-024-03753-4

Abstract

We report on two cases of orthotopic liver transplantation (OLTX) due to SARS-Cov2-associated secondary sclerosing cholangitis (SSC) following long-term artificial respiration and extra-corporal membrane oxygenation in intensive care. Under these conditions, SSC is a rapidly progredient biliary disease featuring degenerative cholangiopathy, loss of bile ducts, ductular and parenchymal cholestasis, biliary fibrosis, and finally cirrhosis. Reduced perfusion and oxygenation of the peribiliary plexus, severe concurrent infections, and secondary medico-toxic effects appear to play a crucial role in the pathogenesis of the disease. A direct cytopathic effect of SARS-Cov2 on endothelial cells followed by thrombosis and fibrosing obliteration in all parts of the vascular bed of the liver may enhance the virus-associated liver disease and particularly SSC.

Keywords: COVID-19 infection; Liver pathology; Liver transplantation; Secondary sclerosing cholangitis; Vasculopathy.