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Covid-related Neonatal Cholestasis?: Liver Transplantation In Three Infants With Intrauterine Or Perinatal Covid Exposure

S. Sakhuja1, K. Patel1, N. T. Galvan2

1Baylor College of Medicine, Houston, TX, 2Baylor College of Medicine, Houston, TX

Meeting: 2022 American Transplant Congress

Abstract number: 9075

Keywords: COVID-19, Infant, Liver failure, Liver transplantation

Topic: Clinical Science » Liver » 61 - Liver: Pediatrics

Session Information

Session Name: Liver: Pediatrics

Session Type: Poster Abstract

Date: Monday, June 6, 2022

Session Time: 7:00pm-8:00pm

 Presentation Time: 7:00pm-8:00pm

Location: Hynes Halls C & D

*Purpose: The COVID pandemic presents a unique set of challenges during pregnancy including thromboembolic complications, direct placental infection, transplacental transmission, and systemic hyperinflammatory state. The liver is the second most commonly affected organ in COVID infection after the lungs. Mechanisms of liver injury in COVID-19 patients include: direct viral cytopathic effect, drug-induced hepatotoxicity, worsening of underlying liver disease, cytokine storm, hypoxic ischemic injury, and cholangiopathy. Post-COVID cholangiopathy leads to marked cholestasis with ongoing jaundice that persists long after other organs have recovered from infection.

*Methods: We describe three infants at Texas Children’s Hospital with intrauterine or perinatal COVID exposure with persistent cholestasis and extrahepatic biliary obstruction (mimicking biliary atresia), suggesting cholangiopathy.

*Results: All three patients described in this case series developed liver failure in the setting of low GGT cholestasis with histologic evidence of extrahepatic biliary obstruction, and all three required liver transplantation within the first year of life.

*Conclusions: Though post-COVID cholangiopathy is described in adults in the literature, our series is unique in that it is the first to describe this phenomenon in infancy. Additionally none of our infants had moderate or severe COVID infection but still progressed to advanced liver disease. Though further studies are needed to determine if additional factors are at play, our case series certainly raises the question of if the timing of exposure/infection might play a role in overall prognosis.

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To cite this abstract in AMA style:

Sakhuja S, Patel K, Galvan NT. Covid-related Neonatal Cholestasis?: Liver Transplantation In Three Infants With Intrauterine Or Perinatal Covid Exposure [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/covid-related-neonatal-cholestasis-liver-transplantation-in-three-infants-with-intrauterine-or-perinatal-covid-exposure/. Accessed May 8, 2025.

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