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

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<0.001), 90-day mortality (24.4% vs. 5.9%, p<0.001) and decreased one-year graft (62.1% vs. 89.4%, p<0.001) and patient survival (55.6% vs 87.9%, p<0.001). 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.