[Fatal fibrosing cholestatic hepatitis following renal transplantation].
A 65-year-old HBsAg positive man developed progressive cholestatic liver enzyme abnormalities with histopathological portoportal septum formation, cholestasis, limited mixed infiltrate and hepatocellular ballooning with a ground glass aspect after renal transplantation. Both clinical and pathological features were characteristic of fibrosing cholestatic hepatitis (FCH), a histological variant of hepatitis-B-virus (HBV) infection with a high mortality rate which affects immunocompromised patients. The diagnosis was made about 9 months after transplantation, after retrospective analysis had shown a postoperative increase in HBV replication. Discontinuation of prednisone treatment and starting antiviral lamivudine therapy reduced HBV DNA load immediately. However due to renal failure caused by hepatorenal syndrome, lamivudine therapy had to be interrupted. The patient died following subacute liver failure with progressive FCH. This case illustrates the importance of early diagnosis and treatment with reduction of immunosuppression and institution of antiviral therapy to prevent progression of FCH in immunocompromised HBsAg positive patients.
Sprengers
D
D
Afd. Maag-, Darm- en Leverziekten, Erasmus Medisch Centrum, Postbus 2040, 3000 CA Rotterdam.
van Gelder
T
T
Zondervan
P E
PE
Niesters
H G M
HG
Janssen
H L A
HL
de Man
R A
RA
D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D002779:Cholestasis / Q000188:drug therapy* / Q000209:etiology; D004279:DNA, Viral / Q000032:analysis / Q000187:drug effects; D017809:Fatal Outcome; D005355:Fibrosis; D006509:Hepatitis B / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects*; D019259:Lamivudine / Q000627:therapeutic use*; D008297:Male; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use; D019562:Viral Load
D000998:Antiviral Agents; D004279:DNA, Viral; D007166:Immunosuppressive Agents; D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine