Liver Transplantation in 3 Cholestatic Infants With History of COVID Exposure

Authors

Shruti Sakhuja
Kalyani R Patel
Matthew Goss
Flor M Munoz
Garrett Wortham
Megan Crawford
John A Goss
Nhu Thao Galvan

Language

English

Publication Date

3-28-2025

Journal

Pediatric and Developmental Pathology

DOI

10.1177/10935266251325335

PMID

40152442

PMCID

PMC12241674 D

PubMedCentral® Posted Date

3-28-2025

PubMedCentral® Full Text Version

Post-print

Abstract

The COVID-19 pandemic presents several 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 SARS-CoV-2 infection after the lungs. Mechanisms of liver injury in COVID-19 patients can include: direct viral cytopathic effect, worsening of underlying liver disease, cytokine storm, hypoxic ischemic injury, and cholangiopathy leading to persistent marked cholestasis. Here we describe 3 infants at Texas Children's Hospital with perinatal SARS-CoV-2 exposure with persistent cholestasis and histologic evidence of extrahepatic biliary obstruction suggesting underlying biliary atresia (BA) with some atypical features possibly exacerbated by SARS-CoV-2 infection. All 3 patients described in this case series developed liver failure in the setting of low GGT cholestasis, and all 3 required liver transplantation within the first year of life. Though post-COVID cholangiopathy is described in adults in the literature, none of the infants in our series had moderate or severe COVID infection but still progressed to advanced liver disease. Instead it is very likely that the patients in our series had underlying BA with some atypical features, with the commonality of having been exposed perinatally to SARS-CoV-2 Though further studies are needed to determine causality, our case series raises the question of if the timing of exposure/infection plays a role in prognosis.

Keywords

SARS-CoV-2, cholestasis, cholangiopathy, pregnancy, neonates, transplant

Published Open-Access

yes

Recommended Citation

Sakhuja, Shruti; Patel, Kalyani R; Goss, Matthew; et al., "Liver Transplantation in 3 Cholestatic Infants With History of COVID Exposure" (2025). Faculty, Staff and Students Publications. 5831.
https://digitalcommons.library.tmc.edu/baylor_docs/5831