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Background: Post‐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. Methods: Seven 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. Results: At 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. Conclusions: Liver 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. [ABSTRACT FROM AUTHOR]

The viral load in a patient's SARS-CoV-2 PCR test can be approximately quantified using the cycle threshold (Ct) value. Although this patient was at a higher risk given recent active infection with low Ct and ongoing disease present, he successfully underwent DDLT given his high risk for mortality due to cirrhosis. For patients with lower Ct values or recent active disease, preoperative monoclonal antibody and perioperative remdesivir may assist in reducing risk for COVID-19 progression in the early posttransplant setting although more studies are needed to determine this. [Extracted from the article]