Acute liver failure in a renal transplant patient caused by adenoviral hepatitis superimposed on a fibrosing cholestatic hepatitis B

Longerich, Thomas; Haferkamp, K.; Töx, Ulrich; Schirmacher, Peter

doi:10.1016/j.humpath.2004.04.004

Cited by 17 publications

(6 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Rarely, adenoviral infections occur in liver allografts. They may mimic CMV‐hepatitis in initial stages, but may proceed to confluent hemorrhagic necroses resulting in graft loss (29). Beside hemorrhagic necroses, the presence of ‘‘smudge cells’’ is a diagnostic feature of adenoviral hepatitis.…”

Section: Biopsy Diagnosis Of Liver Allograftsmentioning

confidence: 99%

General aspects and pitfalls in liver transplant pathology

Longerich

Schirmacher

2006

Clinical Transplantation

View full text Add to dashboard Cite

Pathology in a liver transplant setting addresses four different topics: establishment of a definite diagnosis of the liver disease before listing for transplantation, evaluation of the donor liver with regard to pre-existing diseases, in particular macrovesicular steatosis and fibrosis, assessment of the hepatectomy specimen, and post-transplant biopsy evaluation. Of these, post-transplant biopsy evaluation is the most challenging and clinically the most relevant issue. It requires fast diagnoses to facilitate specific treatment and it has to incorporate a broad spectrum of differential diagnoses. Precise knowledge about rejection, post-transplant therapy, pathology of immunosuppression, and recurrence of the initially underlying liver disease including the characteristic time peaks and atypical histological presentations (e.g., fibrosing cholestatic hepatitis) is needed to evaluate specific and combined histological pictures of liver damage. For adequate interpretation of post-transplant biopsies the hepatopathologist has to be informed about the essential clinico-anamnestic aspects such as time course, medication, imaging results, and serology.

show abstract

Section: Biopsy Diagnosis Of Liver Allograftsmentioning

confidence: 99%

General aspects and pitfalls in liver transplant pathology

Longerich

Schirmacher

2006

Clinical Transplantation

View full text Add to dashboard Cite

show abstract

“…To establish a diagnosis, histological assessment of the liver allograft is mandatory. Whereas acute cellular rejection and graft ischemia can be diagnosed in hematoxylin and eosin‐stained sections, characterization of nuclear alterations suggesting viral infection requires ancillary techniques (4, 8). In our case, the diagnosis of ADV hepatitis was established by immunohistochemical detection of ADV antigen in hepatocytes, and exclusion of other viral etiologies such as CMV, HSV, EBV, and parvovirus infection.…”

Section: Discussionmentioning

confidence: 99%

Successful outcome of severe adenovirus hepatitis of the allograft following liver transplantation

Perez

McCormack

Petrowsky

et al. 2007

Transplant Infectious Dis

View full text Add to dashboard Cite

Here we report the first adult patient who survived severe adenoviral hepatitis of a liver graft, in contrast to 4 previously reported cases in adults, all of which had a fatal outcome. Early diagnosis was based on the immunohistological detection of adenoviral protein in the context of biopsy-proven hepatitis. Dramatic reduction of immunosuppression along with supportive care were the treatment strategies in this case. Adenoviral infection of the allograft should always be considered as a differential diagnosis when clinical signs of severe hepatitis are present after liver transplantation. Accurate diagnosis with immunohistochemical detection of viral proteins in the liver graft is of paramount importance for the early diagnosis and management of this uncommon, severe, and probably underdiagnosed entity.

show abstract

“…Despite its rarity, adenovirus fulminant hepatic failure poses diagnostic and therapeutic challenges after HCT, due to its aggressive clinical course and extremely poor prognosis. In addition to HCT, some patients were reported to have developed fulminant hepatic failure after liver transplantation (22)(23)(24)(25)(26)(27) or renal transplantation (28), or after chemotherapy without undergoing HCT (29)(30)(31)(32)(33). Moreover, other cases were reported without having had any immunosuppressive treatment (34), or some were immunocompetent cases (35,36).…”

Section: Discussionmentioning

confidence: 99%