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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
Summary
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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