title: Hyperbilirubinemia and cholestatic liver injury in hepatitis C-infected liver transplant recipients.
abstract: OBJECTIVE
  A cholestatic pattern of liver injury has been observed in liver transplant recipients with rapidly progressive hepatitis C. We assessed the frequency and causes of cholestasis in hepatitis C-infected liver transplant patients, and evaluated the clinical and pathological course of those with cholestatic hepatitis C.
  
  
  METHODS
  Sixty-nine sequential liver transplant recipients who had detectable hepatitis C viremia were studied retrospectively. Records and diagnostic tests were examined from patients who developed hyperbilirubinemia.
  
  
  RESULTS
  Hyperbilirubinemia occurred in 33 of 69 (48%) hepatitis C-infected liver transplant patients. A thorough evaluation including review of clinical and laboratory data, ultrasound with Doppler, cholangiogram, and liver biopsy identified causes of hyperbilirubinemia other than hepatitis C in 26 of 33 patients. Seven patients developed cholestatic hepatitis C characterized by histological features of recurrent hepatitis C and cholestatic liver injury with ballooning of centrilobular hepatocytes, bile ductular proliferation, and canalicular cholestasis, in the absence of other causes of cholestasis. Five progressed rapidly to bridging fibrosis and two died of complications related to liver failure. Four patients with cholestatic hepatitis C showed extended survival after the onset of hyperbilirubinemia.
  
  
  CONCLUSIONS
  1) Hepatitis C is a relatively infrequent cause of cholestasis in liver transplant recipients. 2) The diagnosis of cholestatic hepatitis C requires a multimodality approach to exclude other causes of cholestasis. 3) Cholestatic hepatitis C ranges in severity and is not always associated with rapid development of graft failure, although significant histological abnormalities are frequent.
authors.affiliation: Department of Medicine, University of Washington Medical Center, Seattle, USA.
authors.forename: S J
authors.initials: SJ
authors.lastname: Cotler
authors.forename: S L
authors.initials: SL
authors.lastname: Taylor
authors.forename: D R
authors.initials: DR
authors.lastname: Gretch
authors.forename: M P
authors.initials: MP
authors.lastname: Bronner
authors.forename: R
authors.initials: R
authors.lastname: Rizk
authors.forename: J D
authors.initials: JD
authors.lastname: Perkins
authors.forename: R L
authors.initials: RL
authors.lastname: Carithers
mesh_terms: D000328:Adult; D001706:Biopsy; D002780:Cholestasis, Intrahepatic / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D019698:Hepatitis C, Chronic / Q000473:pathology*; D006801:Humans; D006932:Hyperbilirubinemia / Q000473:pathology*; D008099:Liver / Q000473:pathology; D017093:Liver Failure / Q000473:pathology; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000473:pathology*; D011379:Prognosis