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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., (© 2023 The Authors. Clinical Transplantation published by John Wiley & Sons Ltd.)

Severe Acute Respiratory Syndrome Coronavirus 2-related Acute-on-chronic Liver Failure. [Extracted from the article]

Hepatitis C, Sofosbuvir, SARS-CoV-2, Daclatasvir. [Extracted from the article]

We read the article by Agarwal et al[1] with great interest about the liver injury in coronavirus disease 2019 (COVID-19). The study suggests that the liver injury in COVID-19 might be partly due to direct injury of cholangiocytes and subsequent accumulation of bile acids by the SARS-CoV-2 infection. In summary, the preliminary studies suggest that the strong predilection for cholangiocyte infection and consequently impaired liver regeneration might be responsible for liver injury in COVID-19. [Extracted from the article]