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Cholestatic hepatitis C in liver allografts
S A Taga1, M K Washington, N Terrault
1Hilo Medical Center, Hilo, HI, USA.
Liver Transplantation and Surgery : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
|July 3, 1998
Summary
Hepatitis C virus (HCV) infection can cause cholestasis in liver transplant recipients, leading to aggressive disease and allograft failure. This aggressive HCV variant shows distinct histological features and higher viral loads.
Area of Science:
- Hepatology
- Virology
- Transplant Immunology
Background:
- Hepatitis C virus (HCV) infection is a concern in liver transplant recipients.
- Some recipients develop hyperbilirubinemia, suggesting a cholestatic variant of HCV.
Purpose of the Study:
- To investigate the histological and virological characteristics of cholestatic hepatitis C in liver transplant recipients.
- To compare these features with non-cholestatic HCV hepatitis in a control group.
Main Methods:
- Evaluation of liver biopsy samples from 6 HCV-positive liver transplant recipients with jaundice.
- Comparison with biopsy samples from HCV hepatitis patients without jaundice.
- Exclusion of patients with known ductopenic rejection, biliary obstruction, or co-infections.
- Measurement of viral titers and genomic typing.
Main Results:
- Patients with cholestasis exhibited more severe histological damage, including interface hepatitis, confluent necrosis, bridging fibrosis, hepatocyte swelling, and ductular proliferation.
- All 6 patients with cholestasis experienced allograft failure, unlike the control group.
- Patients with cholestasis had significantly higher HCV RNA titers compared to the control group.
Conclusions:
- Cholestasis in post-transplant hepatitis C may be driven by an aggressive HCV infection.
- Histological features like confluent necrosis, hepatocyte swelling, and ductular proliferation are indicative of this aggressive form.
- Elevated viral titers are common in patients with cholestatic HCV post-transplantation.