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Bonal M, Mourad M, Bancel B, Hervieu V, Lebossé F, Heyer L, Ducerf C, Lesurtel M, Mabrut JY, Mohkam K. Cholangitis lenta: An underdiagnosed lesion associated with severe cholestasis following liver transplantation. Clin Transplant 2020; 34:e14016. [PMID: 32583551 DOI: 10.1111/ctr.14016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/08/2020] [Accepted: 06/12/2020] [Indexed: 11/30/2022]
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.
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Affiliation(s)
- Mathieu Bonal
- Department of General Surgery and Liver Transplantation, Hospices Civils de Lyon, Université Claude-Bernard Lyon 1, Croix-Rousse University Hospital, Lyon, France
| | - Mohamed Mourad
- Department of General Surgery and Liver Transplantation, Hospices Civils de Lyon, Université Claude-Bernard Lyon 1, Croix-Rousse University Hospital, Lyon, France.,INSERM Unit 1052 Epigenetics and Epigenomics in Liver Cancers, Cancer Research Center of Lyon, Lyon, France
| | - Brigitte Bancel
- Department of Surgical Pathology, Hospices Civils de Lyon, Groupement Hospitalier Est, Lyon, France
| | - Valérie Hervieu
- Department of Surgical Pathology, Hospices Civils de Lyon, Groupement Hospitalier Est, Lyon, France
| | - Fanny Lebossé
- Department of Hepatology, Hospices Civils de Lyon, Université Claude-Bernard Lyon 1, Croix-Rousse University Hospital, Lyon, France
| | - Laurent Heyer
- Intensive Care Unit, Hospices Civils de Lyon, Croix-Rousse University Hospital, Lyon, France
| | - Christian Ducerf
- Department of General Surgery and Liver Transplantation, Hospices Civils de Lyon, Université Claude-Bernard Lyon 1, Croix-Rousse University Hospital, Lyon, France
| | - Mickaël Lesurtel
- Department of General Surgery and Liver Transplantation, Hospices Civils de Lyon, Université Claude-Bernard Lyon 1, Croix-Rousse University Hospital, Lyon, France.,INSERM Unit 1052 Epigenetics and Epigenomics in Liver Cancers, Cancer Research Center of Lyon, Lyon, France
| | - Jean-Yves Mabrut
- Department of General Surgery and Liver Transplantation, Hospices Civils de Lyon, Université Claude-Bernard Lyon 1, Croix-Rousse University Hospital, Lyon, France.,INSERM Unit 1052 Epigenetics and Epigenomics in Liver Cancers, Cancer Research Center of Lyon, Lyon, France
| | - Kayvan Mohkam
- Department of General Surgery and Liver Transplantation, Hospices Civils de Lyon, Université Claude-Bernard Lyon 1, Croix-Rousse University Hospital, Lyon, France.,INSERM Unit 1052 Epigenetics and Epigenomics in Liver Cancers, Cancer Research Center of Lyon, Lyon, France
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