Hepatitis C virus-associated fibrosing cholestatic hepatitis after renal transplantation: response to interferon-alpha therapy.
Fibrosing cholestatic hepatitis (FCH) has recently been described after solid organ transplantation in patients with hepatitis C virus (HCV) infection. Typically, FCH is characterized by an ominous clinical course leading to progressive hepatic failure and death if liver transplantation is not performed. Two HCV-infected patients underwent cadaveric renal transplantation for end-stage renal disease resulting from membranous nephropathy and diabetic nephropathy. The time intervals between transplantation and the biopsy diagnosis of FCH for the two patients were 7 months and 10 years. Both patients presented with jaundice, hyperbilirubinemia, and mild-to-moderate elevations in serum aspartate aminotransferase. One patient was also found to have type II mixed cryoglobulinemia. Interferon-alpha therapy was begun after a diagnosis of FCH was established by liver biopsy. Liver test abnormalities normalized rapidly. When cholestatic hepatic deterioration develops in an HCV-infected organ allograft recipient, the diagnosis of FCH should be considered and a liver biopsy performed. Our observations indicate that FCH can respond to antiviral therapy.
Toth
C M
CM
Transplantation Unit, Massachusetts General Hospital, and Harvard Medical School, Boston 02114, USA.
Pascual
M
M
Chung
R T
RT
Graeme-Cook
F
F
Dienstag
J L
JL
Bhan
A K
AK
Cosimi
A B
AB
D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D002780:Cholestasis, Intrahepatic / Q000188:drug therapy / Q000209:etiology* / Q000821:virology; D016174:Hepacivirus / Q000276:immunology; D006526:Hepatitis C / Q000150:complications* / Q000188:drug therapy; D018937:Hepatitis C Antibodies / Q000097:blood; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects*; D008103:Liver Cirrhosis / Q000188:drug therapy / Q000209:etiology* / Q000821:virology; D008297:Male; D008875:Middle Aged
D000998:Antiviral Agents; D018937:Hepatitis C Antibodies; D016898:Interferon-alpha