Severe recurrent cholestatic hepatitis C following orthotopic liver transplantation

TLDR

Recurrent HCV infection is nearly universal after orthotopic liver transplantation, but its clinical severity varies. The study aims to describe a progressive, severe cholestatic form of hepatitis in a subset of patients with recurrent HCV after liver transplantation. The authors reviewed data from 135 liver transplant recipients for hepatitis C cirrhosis and identified 10 patients with severe recurrent cholestatic hepatitis. Ten patients developed severe progressive cholestatic hepatitis, with mean bilirubin 24.7 mg/dL at retransplantation, mild initial histology but cirrhosis or necrosis in failed grafts, cholestasis onset within five months, indicating that a minority of recurrent HCV cases progress to liver failure.

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.