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Severe recurrent cholestatic hepatitis C following orthotopic liver transplantation
L K Schluger1, P A Sheiner, S N Thung
1Department of Medicine, Mount Sinai Medical Center of the City University of New York, USA.
Insights
Recurrent hepatitis C virus (HCV) infection post-liver transplant can cause severe, progressive cholestatic hepatitis. A subset of patients develop liver failure, necessitating retransplantation.
Area of Science:
- Hepatology
- Transplantation Immunology
- Virology
Background:
- Recurrent hepatitis C virus (HCV) infection is common after liver transplantation.
- Clinical outcomes of recurrent HCV vary significantly among patients.
Purpose of the Study:
- To identify and characterize a severe, progressive cholestatic form of hepatitis in patients with recurrent HCV post-orthotopic liver transplantation.
- To investigate the clinical course and outcomes of this severe cholestatic hepatitis.
Main Methods:
- Retrospective review of data from 135 patients who underwent liver transplantation for hepatitis C cirrhosis.
- Identification of a subgroup of 10 patients with severe recurrent hepatitis C and progressive cholestatic hepatitis.
Main Results:
- Ten patients developed severe progressive cholestatic hepatitis, with a mean bilirubin rise to 24.7 mg/dL before retransplantation.
- Histology showed mild hepatitis initially, with failed grafts exhibiting cirrhosis or hepatic necrosis.
- Cholestasis onset preceded retransplantation by less than 5 months.
Conclusions:
- A minority of liver transplant recipients with recurrent HCV develop severe progressive cholestatic hepatitis.
- This severe form can lead to liver failure and the need for retransplantation.
Abstract:
Recurrent infection with hepatitis C virus (HCV) is almost universal following orthotopic liver transplantation although clinical severity varies. Data on 135 patients who underwent transplantation for hepatitis C cirrhosis were reviewed. We describe a progressive, severe cholestatic form of hepatitis occurring in a subgroup of patients with recurrent hepatitis C. Ten patients with severe recurrent hepatitis C were identified; 1 has died, 1 awaits retransplantation, and 8 have undergone retransplantation. All 10 developed severe progressive cholestatic hepatitis, with a mean rise in bilirubin to 24.7 mg/dL at the time of retransplantation. Histology at initial recurrence was of mild hepatitis without evidence of rejection. The failed grafts showed either cirrhosis or confluent hepatic necrosis. The onset of cholestasis preceded retransplantation by less than 5 months. Our study suggests that a minority of patients with recurrent hepatitis C after undergoing liver transplantation develop a severe progressive cholestatic hepatitis and liver failure.