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Liver transplantation for post-COVID-19 sclerosing cholangitis
  1. Angela Lee1,
  2. Alexander N Wein2,
  3. Maria B Majella Doyle3 and
  4. William C Chapman3
  1. 1Department of Surgery, Washington University in St Louis School of Medicine, St. Louis, Missouri, USA
  2. 2Department of Pathology and Immunology, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
  3. 3Section of Abdominal Organ Transplant, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
  1. Correspondence to Dr Angela Lee; angela1{at}


Since identified in December 2019, COVID-19 has remained a pandemic across the globe. Although primarily a respiratory illness, the impact of COVID-19 on other end organs has been increasingly identified. The effect of COVID-19 on the liver has yet to be completely understood. We describe a case of COVID-19 leading to end-stage cholangiopathy and deceased donor liver transplantation (LT). A 64-year-old man with no underlying respiratory or liver disease presented with acute respiratory distress secondary to COVID-19 pneumonia requiring intubation. Several months after resolution of his respiratory symptoms, he developed transaminitis, worsening jaundice, abdominal pain and dark-coloured urine. Hepatic function remained severely impaired warranting LT 259 days following his initial COVID-19 diagnosis. Explant pathology demonstrated diffuse hepatic injury, onion skinning of the bile ducts and bile duct loss in scattered portal tracts. As more patients develop COVID-19-related complications, we suggest LT as an option for COVID-19-related end-stage liver disease.

  • transplantation
  • COVID-19

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  • Contributors AL conducted data collection and wrote the manuscript. AW contributed pathology analysis and write-up. MBMD and WC led case report organisation, analysis and editing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.