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. 2020 Sep;34(9):e14016.
doi: 10.1111/ctr.14016. Epub 2020 Jul 17.

Cholangitis lenta: An underdiagnosed lesion associated with severe cholestasis following liver transplantation

Mathieu Bonal  1 , Mohamed Mourad  1   2 , Brigitte Bancel  3 , Valérie Hervieu  3 , Fanny Lebossé  4 , Laurent Heyer  5 , Christian Ducerf  1 , Mickaël Lesurtel  1   2 , Jean-Yves Mabrut  1   2 , Kayvan Mohkam  1   2
Affiliations

Cholangitis lenta: An underdiagnosed lesion associated with severe cholestasis following liver transplantation

Mathieu Bonal et al. Clin Transplant. 2020 Sep.

Abstract

Background: Cholangitis lenta (CL) represents a specific histological lesion associated with severe cholestasis and related to sepsis. Despite being well known by pathologists, CL has been poorly studied in liver transplantation (LT).

Methods: We performed a retrospective 12-year analysis of the incidence, risk factors, and outcome of CL in LT recipients. Biopsy samples performed within 3 months after LT underwent blinded rereading to identify recipients with CL.

Results: Among 587 LT performed, 45 (7.7%) developed CL. Of these, 7 (15.6%) had no signs of clinical sepsis at the time of biopsy, but further investigations revealed positive cultures. Independent factors associated with CL were sepsis at the time of LT (OR = 3.62 [95%CI = 1.63-8.06]), donor age (OR = 1.05 [1.03-1.08]), and operative time (OR = 1.23 [95%CI = 1.02-1.48]). Cholangitis lenta was associated with increased severe morbidity (71.1% vs 33.0%, P < .001), 90-day mortality (24.4% vs 5.9%, P < .001) and decreased one-year graft (62.1% vs 89.4%, P < .001) and patient survival (55.6% vs 87.9%, P < .001).

Conclusion: Cholangitis lenta represents a possible lesion associated with cholestasis after LT, which strongly affects its outcome. In the event of an unexplained post-transplant cholestasis, the diagnosis of CL must be considered, even in the absence of clinically evident sepsis.

Keywords: biopsy; cholestasis; liver; sepsis; survival; transplant.

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References

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