Sclerosing cholangitis associated to cryptosporidiosis in liver-transplanted children

Three children of a series of 461 pediatric liver transplant recipients dev eloped diffuse cholangitis associated with intestinal cryptosporidium carri age. All three received immunosuppression consisting of tacrolimus and pred nisone. Cryprosporidium carriage was treated with paramomycin, while immuno suppression was decreased according to graft tolerance. No other infectious pathogens were found, and no vascular problems were detected. Bile duct an astomosis was reoperated in all three: but biliary cirrhosis developed in o ne patient, requiring retransplantation. All three patients are alive and w ell, and free of intestinal parasites on follow-up. Conclusion Cryptosporidium intestinal infection may play a role in some cas es of otherwise unexplained cholangiopathies in pediatric liver transplant recipients. This may lead to significant morbidity, including need for retr ansplantation.