Hepatitis C virus-associated fibrosing cholestatic hepatitis after renal transplantation: response to interferon-alpha therapy

Transplantation. 1998 Nov 15;66(9):1254-8. doi: 10.1097/00007890-199811150-00023.

Abstract

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.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Antiviral Agents / therapeutic use
  • Cholestasis, Intrahepatic / drug therapy
  • Cholestasis, Intrahepatic / etiology*
  • Cholestasis, Intrahepatic / virology
  • Hepacivirus / immunology
  • Hepatitis C / complications*
  • Hepatitis C / drug therapy
  • Hepatitis C Antibodies / blood
  • Humans
  • Interferon-alpha / therapeutic use
  • Kidney Transplantation / adverse effects*
  • Liver Cirrhosis / drug therapy
  • Liver Cirrhosis / etiology*
  • Liver Cirrhosis / virology
  • Male
  • Middle Aged

Substances

  • Antiviral Agents
  • Hepatitis C Antibodies
  • Interferon-alpha