A unique case of ischemic cholangiopathy following treatment of hepatocellular carcinoma requiring liver transplantation

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Conference Proceeding

Publication Date


Publication Title

Am J Gastroenterol


Introduction: Ischemic cholangiopathy is a hepatobiliary condition that involves focal or diffuse extensive damage to the bile ducts due to impaired blood supply. We present a unique case of Ischemic Cholangiopathy following treatment for HCC leading to liver transplantation. Case Description/Methods: A 53-year-old female with a history of Non-alcoholic steatohepatitis and hepatocellular carcinoma (HCC) presents with worsening laboratory findings. Liver masses were first detected in 2011 and were attributed to oral contraceptive use. Magnetic Resonance Imaging done in 2014 following consistently elevated liver enzymes showed multiple atypical appearing lesions. Subsequent percutaneous biopsy revealed a well-developed hepatocellular neoplasm favoring HCC diagnosis. The patient then received two non-selective drug-eluting bead transarterial chemoembolizations (DEB-TACE) involving the left and right lobes to achieve destruction of the lesions. Follow-up evaluations of magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) revealed abnormal ductal anatomy and pruned and diffusely strictured intrahepatic bile ducts, consistent with a post-radiation effect. Post-ERCP, the patient's course was further complicated by Cholangitis with Extended-Spectrum Beta-Lactamase E. Coli. Two weeks post-ERCP, she was hospitalized for an intrahepatic abscess with likely communication to the biliary tree that required pigtail drain placement with drainage that grew ESBL E. coli and received a prolonged course of antibiotics. The abscess worsened over time despite continued treatment, resulting in a peritoneal-pleural fistula that required a prolonged admission and ultimately a right thoracoscopy, decortication, and resection of the right lower lobe of the lung for source control management. The patient had a peak alkaline phosphate of 1688 IU/L and a peak total bilirubin of 4.9 mg/dL prior to liver transplantation. The patient finally underwent Orthotopic Liver Transplant with no intraoperative complications. Ex-plant pathology revealed focal HCC. Three years post-liver transplantation, the patient remains stable with very good clinical profile, with the last reported alkaline phosphate level of 51 IU/L and total bilirubin of 0.9 mg/dL. Discussion: This is a unique case of Ischemic Cholangiopathy with recurrent cholangitis following treatment for Hepatocellular Carcinoma. Patent underwent successful hepatic transplantation with no evidence of recurrence of HCC or cholangiopathy .

PubMed ID

Not assigned.





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