Fibrosing cholestatic hepatitis in a kidney transplant recipient with hepatitis C virus

Abstract

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.

Transplantation of kidneys from hepatitis C–infected donors to hepatitis C–negative recipients: Single center experience

“…Therefore, it is difficult to predict which recipients will develop high levels of early viremia, which may be associated with consequences such as severe hepatitis as we experienced in one recipient, with complete resolution after treatment of HCV. 19,20 In our cohort, none of the other patients developed severe liver-related complications. The majority of our recipients experienced mild to moderate elevations in aminotransferase levels with normal bilirubin levels.…”

“…Unfortunately, UNOS does not routinely report viremia levels for donors. Therefore, it is difficult to predict which recipients will develop high levels of early viremia, which may be associated with consequences such as severe hepatitis as we experienced in one recipient, with complete resolution after treatment of HCV . In our cohort, none of the other patients developed severe liver‐related complications.…”

Revolution in the diagnosis and management of hepatitis C virus infection in current era

“…Moreover, 4 recipients in this study population had concomitant HIV infection. Shinzato et al [ 195 ] reported a case of post renal transplant FCH treated with GLE/PIB combination. The patient expired due to progressive hepatic failure despite decreased HCV viral load.…”

Fibrosing cholestatic hepatitis as a variant of the course of hepatotropic viruses’ infection

“…К сожалению, у реципиента почки, о котором сообщают авторы из Японии, ФХГ протекал очень быстро и комбинация глекапревира и пибрентасвира к успеху не привела. Пациент умер при явлениях печёночной недостаточности[57]. Несмотря на успехи в эрадикации вируса, которая достигается у большинства реципиентов печени с ФХГ С, фиброз регрессирует только у половины из них.…”