Fibrosing cholestatic hepatitis in a kidney transplant recipient with hepatitis C virus
Fibrosing cholestatic hepatitis (FCH) is a fatal disorder that presents as a progressive deterioration of liver function over a period of several weeks to several months. It is caused by the direct cytotoxic effect of the over-expression of viral antigens on hepatocytes in immunosuppressed patients. Our patient was a 59-year-old man with hepatitis C virus (HCV) infection of genotype 2a who had suffered from end-stage renal disease due to diabetic nephropathy and underwent kidney transplantation. His serum total bilirubin levels gradually increased to 20 mg/dl and liver atrophy progressed during several weeks after kidney transplantation, which was initially difficult to distinguish from drug-induced liver injury. We diagnosed the condition as FCH on the basis of pathological findings and increased HCV viral load, and treated the patient with Glecaprevir/Pibrentasvir. However, the patient died of refractory hemorrhagic gastric ulcer and liver failure. Currently, it is possible to treat infections of all genotypes of HCV, even with end-stage renal disease, with direct acting antivirals. Furthermore, it is preferable to treat HCV before kidney transplantation considering the risk of FCH due to immunosuppressive therapy.
KeywordsFibrosing cholestatic hepatitis Kidney transplantation Hepatitis C
We would like to thank Professor Norio Isoda, department of hepatology, Jichi Medical University Hospital, Japan, for his great contribution.
Compliance with ethical standards
Conflict of interest
All the authors have declared no competing interest.
Human and animal rights
This article does not contain any studies with human participants performed by any of the authors.
Written informed consent obtained from the patient.
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