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Cryoglobulinemia presenting after liver transplantation

J Gournay1, L D Ferrell, J P Roberts

  • 1Department of Medicine, University of California, San Francisco, USA.

Gastroenterology
|January 1, 1996
PubMed

Insights

Essential mixed cryoglobulinemia, often linked to hepatitis C, can manifest post-liver transplant. This study highlights three cases where cryoglobulinemia with vasculitis emerged after transplantation, emphasizing the role of hepatitis C virus (HCV) infection.

Area of Science:

  • Nephrology
  • Hepatology
  • Immunology

Background:

  • Essential mixed cryoglobulinemia is commonly associated with chronic hepatitis C infection.
  • Hepatitis C virus (HCV) is a significant etiologic factor in the development of cryoglobulinemia.

Observation:

  • This report details three patients who developed cryoglobulinemia with vasculitis after undergoing liver transplantation for end-stage chronic hepatitis C.
  • HCV infection was confirmed via HCV RNA detection. Vasculitis symptoms appeared 1, 5, and 17 months post-transplantation.
  • Patients presented with Type II cryoglobulins, cutaneous vasculitis, and in two cases, membranoproliferative glomerulonephritis.

Findings:

  • Post-transplant cryoglobulinemia can present with severe manifestations including cutaneous vasculitis and glomerulonephritis.
  • Treatment responses varied; one patient improved with plasmapheresis and cyclophosphamide, while another experienced irreversible renal failure.
  • Complications included digital amputation, autoimmune hemolytic anemia, and multiorgan failure, leading to one fatality.

Implications:

  • HCV-associated cryoglobulinemia may become clinically significant after liver transplantation, potentially due to increased post-transplant viremia.
  • These findings underscore the importance of monitoring for cryoglobulinemia in HCV-infected patients post-transplantation.
  • Further research is warranted to understand the mechanisms driving post-transplant cryoglobulinemia and to optimize management strategies.

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