[Fatal acute hepatic failure with hepatocarcinoma presentation in a patient with renal transplant with asymptomatic chronic B and C hepatitis].
Hepatocellular carcinoma is a primary tumor complicating liver disease, associated with cirrhosis in 80-90% of the cases. A kidney transplant recipient with chronic B and C viral hepatitis was admitted because of general malaise, renal function impairment and positive AST, ALT and alkaline phosphatase tests, and very high alpha-fetoprotein levels. Ascites, spontaneous bacterial peritonitis and renal failure developed. A CT showed multiple liver masses. Renal failure required hemodialysis. The patient died 17 days after the initial symptoms with hepatic encephalopathy. A postmortem liver biopsy confirmed the diagnosis of cirrhosis and hepatocellular carcinoma (HCC). This report, as well as a few others, shows the accelerated evolution of chronic viral hepatitis in kidney transplant patients and questions the convenience of kidney transplantation and the adequate follow up in chronic viral hepatitis.
Ridruejo
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Sección Hepatología, Departamento de Medicina, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina. eridruejo@cemic.edu.ar
Avagnina
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Davalos Michel
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Mandó
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D000208:Acute Disease; D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000150:complications*; D017809:Fatal Outcome; D006501:Hepatic Encephalopathy / Q000209:etiology*; D019694:Hepatitis B, Chronic / Q000150:complications; D019698:Hepatitis C, Chronic / Q000150:complications; D006521:Hepatitis, Chronic / Q000150:complications*; D006801:Humans; D016030:Kidney Transplantation; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000209:etiology; D008113:Liver Neoplasms / Q000150:complications*; D008297:Male