Surgery Today

, Volume 40, Issue 10, pp 982–985 | Cite as

Early diagnosis and treatment resolved cholestatic hepatitis C without fibrosis after living donor liver transplantation: Report of a case

  • Takasuke Fukuhara
  • Kazutoyo Morita
  • Kazuki Takeishi
  • Takeo Toshima
  • Kenji Umeda
  • Shigeyuki Nagata
  • Keishi Sugimachi
  • Toru Ikegami
  • Tomonobu Gion
  • Yuji Soejima
  • Akinobu Taketomi
  • Yoshihiko Maehara
Case Report

Abstract

Cholestatic hepatitis is a life-threatening recurrent pattern of hepatitis C virus (HCV) in immunosuppressed patients, for which curative treatment has not yet been established. We report the successful treatment of cholestatic hepatitis in a 59-year-old man who had undergone right lobe living donor liver transplantation (LDLT) for liver cirrhosis (LC) caused by HCV. Following uneventful surgery and an uncomplicated posttransplant clinical course, there was an abrupt increase in total bilirubin in comparison to aminotransferase on postoperative day (POD) 60 (total bilirubin 16.2 mg/dl, alanine aminotransferase 100 U/l, HCV-RNA 390 kIU/ml). The histological findings of the liver tissue showed lymphocyte infiltration in the periportal zone and severe cholestasis. Considering the clinical course, cholestatic hepatitis was strongly suspected and pegylated interferon and ribavirin therapy was started immediately, resulting in not only a viral response, but minimal progression of fibrosis. This case serves to demonstrate that early diagnosis and timely initiation of optimal antiviral therapy is essential for the resolution of cholestatic hepatitis C.

Key words

Cholestatic hepatitis Hepatitis C virus Interferon Ribavirin Splenectomy 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Brown RS Jr. Hepatitis C and liver transplantation. Nature 2005;436:973–978.CrossRefPubMedGoogle Scholar
  2. 2.
    Marubashi S, Dono K, Miyamoto A, Takeda Y, Nagano H, Umeshita K, et al. Liver transplantation for hepatitis C. J Hepatobiliary Pancreat Surg 2006;13:382–392.CrossRefPubMedGoogle Scholar
  3. 3.
    Neumann UP, Berg T, Bahra M, Puhl G, Gucklberger O, Langrehr JN, et al. Long-term outcome of liver transplantation for chronic hepatitis C: a 10-year follow-up. Transplantation 2004;77:226–231.CrossRefPubMedGoogle Scholar
  4. 4.
    Lim HL, Lau GK, Davis GL, Dolson DJ, Lau JY. Cholestatic hepatitis leading to hepatic failure in a patient with organtransmitted hepatitis C virus infection. Gastroenterology 1994; 106(1):248–251.Google Scholar
  5. 5.
    Zylberberg H, Carnot F, Mamzer M, Blancho G, Legendre C, Pol S. Hepatitis C virus-related fibrosing cholestatic hepatitis after renal transplantation. Transplantation 1997;63(1):158–160.CrossRefPubMedGoogle Scholar
  6. 6.
    Schluger LK, Sheiner PA, Thung SN, Lau JY, Min A, Wolf DC, et al. Severe recurrent cholestatic hepatitis following orthotopic liver transplantation. Hepatology 1996;23:971–976.CrossRefPubMedGoogle Scholar
  7. 7.
    McCaughan GW, Zekry A. Mechanisms of HCV reinfection and allograft damage after liver transplantation. J Hepatol 2004;40: 368–374.CrossRefPubMedGoogle Scholar
  8. 8.
    Dixon LR, Crawford JM. Early histologic changes in fibrosing cholestatic hepatitis C Liver Transpl 2007;13:219–226.Google Scholar
  9. 9.
    Tolan DJ, Davies MH, Millson CE. Fibrosing cholestatic hepatitis after liver transplantation in a patient with hepatitis C and HIV infection. N Engl J Med 2001;345(24):1781.CrossRefPubMedGoogle Scholar
  10. 10.
    Fang JWS, Wright TL, Lau JYN. Fibrosing cholestatic hepatitis in patients with HIV and hepatitis B. Lancet 1993;342:1175.CrossRefPubMedGoogle Scholar
  11. 11.
    Dickson RC, Caldwell SH, Ishitani MB, Lau JYN, Driscoll CJ, Stevenson WC, et al. Clinical and histologic patterns of early graft failure due to recurrent hepatitis C in your patients after liver transplantation. Transplantation 1996;61(5):701–705.CrossRefPubMedGoogle Scholar
  12. 12.
    Rosenberg PM, Farrell JJ, Abraczinskas DR, Graeme-Cook FM, Dienstag JL, Chung RT. Rapidly progressive fibrosing cholestatic hepatitis-hepatitis C virus in HIV coinfection. Am J Gastroenterol 2002;97:478–483.CrossRefPubMedGoogle Scholar
  13. 13.
    Pessoa MG, Bzowej N, Berenguer M, Phung Y, Kim M, Ferrell L, et al. Evolution of hepatitis C virus quasispecies in patients with severe cholestatic hepatitis after liver transplantation. Hepatology 1999;30:1513–1520.CrossRefPubMedGoogle Scholar
  14. 14.
    Doughty AL, Painter DM, McCaughan GW. Post-transplant quasispecies pattern remains stable over time in patients with recurrent cholestatic hepatitis due to hepatitis C virus. J Hepatol 2000;32:126–134.CrossRefPubMedGoogle Scholar
  15. 15.
    Sohara N, Takagi H, Kakizaki S, Sato K, Mori M. The use of partial splenic artery embolization made it possible to administer interferon and ribavirin therapy in a liver transplant patient with fibrosing cholestatic hepatitis C complicated with thrombocytopenia. Transpl Int 2006;19:255–257.CrossRefPubMedGoogle Scholar
  16. 16.
    Ikegami T, Shimada M, Imura S, Arakawa Y, Nii A, Morine Y, et al. Current concept of small-for size grafts in living donor liver transplantation. Surg Today 2008;38:971–982.CrossRefPubMedGoogle Scholar
  17. 17.
    Yoshizumi T, Taketomi A, Soejima Y, Ikegami T, Uchiyama H, Kayashima H, et al. The beneficial role of simultaneous splenectomy in living donor liver transplantation in patients with smallfor-size graft. Transpl Int 2008;21:833–842.CrossRefPubMedGoogle Scholar

Copyright information

© Springer 2010

Authors and Affiliations

  • Takasuke Fukuhara
    • 1
  • Kazutoyo Morita
    • 1
  • Kazuki Takeishi
    • 1
  • Takeo Toshima
    • 1
  • Kenji Umeda
    • 1
  • Shigeyuki Nagata
    • 1
  • Keishi Sugimachi
    • 1
  • Toru Ikegami
    • 1
  • Tomonobu Gion
    • 1
  • Yuji Soejima
    • 1
  • Akinobu Taketomi
    • 1
  • Yoshihiko Maehara
    • 1
  1. 1.Department of Surgery and Science, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan

Personalised recommendations