Rapid progression of hepatitis C-induced liver failure in renal allograft recipients

Early mortality due to hepatitis C virus (HCV)-related liver failure in renal allograft recipients in the absence of fibrosing cholestatic hepatitis is reported infrequently. We report six renal allograft recipients with HCV infection who died of rapid progression to liver failure. Of these, 2 were detected anti-HCV positive at screening prior to kidney transplantation and 4 were diagnosed after transplantation following derangement of liver function (HCV RNA positive in all 4, anti-HCV positive in 2). Median interval between kidney transplantation and derangement of liver function was 11.8 months (range 2 to 25) and median interval between transplant and death was 27 months (range 11 to 53). Liver biopsy performed during the terminal illness in 3 patients and post-mortem liver histology in 2 patients showed chronic hepatitis with mean grade of 10.2 (range 9 to 12) and stage 2.4 (range 2 to 3). None had features of fibrosing cholestatic hepatitis.