Clinical characterization of patients developing histologically-proven fibrosing cholestatic hepatitis C post-liver transplantation

Authors


  • Author contribution: All authors equally contributed in the concept, design, analysis and interpretation of data. Initial drafting of the manuscript was done by S. K. S. Critical revision of the manuscript for important intellectual content was done by all authors. Statistical analysis was performed by S. K. S. No funding was obtained for the current study. This study was supervised by T. S.

  • Declaration of interest: No conflicts of interest exist.

  • Presented in poster form at the 59th Annual Meeting of the American Association for the Study of Liver Diseases, San Francisco, CA, USA. Hepatology 2008; 45: 578A.

  • Presented as oral presentations at the Young Investigator's Forum of the Breckenridge Controversies in Transplantation meeting, 6 March 2008, Beaver Run Resort, CO, USA.

Professor Thomas Schiano, Mount Sinai School of Medicine, Division of Liver Diseases, Box 1104, One Gustave L Levy Place, New York, NY 10029-6574, USA. Email: thomas.schiano@mountsinai.org

Abstract

Aim:  Fibrosing cholestatic hepatitis C (FCH) post-liver transplantation (LT) is an uncommon disorder with extremely poor outcome. Using stringent histological criteria, we sought to identify cases of FCH to better characterize its incidence, clinical features and outcomes.

Methods:  From January 1991 to December 2007, 973 LT for hepatitis C virus (HCV) were performed at our center. Using the pathology database, 51 cases with a provisional diagnosis of FCH were identified. FCH was diagnosed histologically by cholestasis accompanied by thin periportal fibrous septa, ductular reaction and mild inflammation.

Results:  FCH was reconfirmed in 24 recipients; seven had concurrent biliary problems. Twenty-seven cases were excluded; biopsy was unavailable in nine cases, 15 did not meet the histological criteria of FCH and three had missing clinical information. All received deceased donors at a mean age of 64.4 years (15/17 aged >50 years). Mean time from LT to FCH was 7.6 months with 16 of 17 diagnosed within 1 year of LT. At diagnosis, mean viral load was 14.4 million IU/mL, bilirubin 16.2 mg/dL, aspartate aminotransferase 262 IU/mL, alanine aminotransferase 192 IU/mL and alkaline phosphatase 299 IU/mL. All 17 patients died or required re-LT a mean of 7.8 months after the FCH diagnosis.

Conclusion:  FCH occurs infrequently and is typified by hyperbilirubinemia, donor age of more than 50 years, extremely high HCV RNA and specific histological changes occurring within the first several months post-LT with extremely poor patient and graft survival. Histology alone is not reliable for the diagnosis of FCH, especially in the setting of recurrent HCV with concurrent biliary problems.

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