Recurrent infection with hepatitis C virus (HCV) is has become increasingly apparent that recurrent disalmost universal following orthotopic liver transplantaease can be progressive and may result in poorer long tion although clinical severity varies. Data on 135 paterm survival. 7,8 tients who underwent transplantation for hepatitis C
A severe form of fibrosing cholestatic hepatitis charcirrhosis were reviewed. We describe a progressive, seacterized by rapidly progressive graft dysfunction has vere cholestatic form of hepatitis occurring in a subbeen described in patients who underwent transplantagroup of patients with recurrent hepatitis C. Ten pation for hepatitis B. 9 There have been very few reports tients with severe recurrent hepatitis C were identified; of progressive cholestatic liver disease from HCV lead-1 has died, 1 awaits retransplantation, and 8 have undering to subfulminant hepatic failure after orthotopic gone retransplantation. All 10 developed severe progresliver transplantation. We report here on 10 patients sive cholestatic hepatitis, with a mean rise in bilirubin to 24.7 mg/dL at the time of retransplantation. Histology who underwent transplantation for hepatitis C cirrhoat initial recurrence was of mild hepatitis without evisis who developed severe progressive cholestatic liver dence of rejection. The failed grafts showed either cirdisease leading to liver failure and/or retransplantarhosis or confluent hepatic necrosis. The onset of choletion. We describe the pathological, biochemical, and stasis preceded retransplantation by less than 5 months. clinical characteristics of these patients.
Our study suggests that a minority of patients with recurrent hepatitis C after undergoing liver transplanta-PATIENTS AND METHODS tion develop a severe progressive cholestatic hepatitis and liver failure. (HEPATOLOGY 1996;23:971-976.)
Patients. We reviewed data on 135 consecutive patients transplanted for hepatitis C at the Mount Sinai Medical Center, New York, NY, between September 1988 and December Hepatitis C is a well-known cause of end-stage liver 1993. Among this series of 135 patients, the first 100 cases disease leading to transplantation. After transplantaformed the basis for an earlier report on the incidence of recurrent hepatitis C after undergoing transplantation. 10 We tion, recurrent infection (serum hepatitis C virus identified 56 of 135 patients with recurrent hepatitis C, de-
[HCV]-RNA positive by polymerase chain reaction fined as elevated aminotransferase activities in the presence [PCR]) is almost universal. 1 Recurrent disease (histoof compatible liver biopsy findings. Twelve of these 56 palogical hepatitis) has been reported in 15% to 65% of tients had progressive cholestasis manifested biochemically patients who underwent transplantation for hepatitis by rising bilirubin levels disproportionate to the rise in ami- C, with most programs reporting rates of approxinotransferase levels. In 2 of the 12 patients who underwent mately 45%. [1][2][3][4][5][6] Although the majority of patients who retransplantation, the explanted livers showed changes of underwent transplantation for hepatitis C do well, it chronic rejection with ductopenia. These 2 cases were ex- cluded from further analysis. Of the remaining 10 patients, 8 underwent retransplantation, 1 died, and 1 awaits retransplantation. Liver biopsy specimens obtained at the time of Abbreviations: HCV, hepatitis C virus; PCR, polymerase chain reaction; H& diagnosis of recurrent disease, at the time of clinical diagno-E, hematoxylin and eosin; HBcAg, hepatitis B core antigen; HBsAg, hepatitis B sis of cholestasis (bilirubin ΓΊ 3.0 mg/dL), and from the 8 surface antigen.