Clinical characterization of patients developing histologically-proven fibrosing cholestatic hepatitis C post-liver transplantation

Sanjaya Satapathy, Seth Sclair, M. Isabel Fiel, Juan Del Rio Martin, Thomas Schiano

Research output: Contribution to journalArticle

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Abstract

Aim: Fibrosing cholestatic hepatitis C (FCH) post-liver transplantation (LT) is an uncommon disorder with extremely poor outcome. Using stringent histological criteria, we sought to identify cases of FCH to better characterize its incidence, clinical features and outcomes. Methods: From January 1991 to December 2007, 973 LT for hepatitis C virus (HCV) were performed at our center. Using the pathology database, 51 cases with a provisional diagnosis of FCH were identified. FCH was diagnosed histologically by cholestasis accompanied by thin periportal fibrous septa, ductular reaction and mild inflammation. Results: FCH was reconfirmed in 24 recipients; seven had concurrent biliary problems. Twenty-seven cases were excluded; biopsy was unavailable in nine cases, 15 did not meet the histological criteria of FCH and three had missing clinical information. All received deceased donors at a mean age of 64.4years (15/17 aged >50years). Mean time from LT to FCH was 7.6months with 16 of 17 diagnosed within 1year of LT. At diagnosis, mean viral load was 14.4million IU/mL, bilirubin 16.2mg/dL, aspartate aminotransferase 262IU/mL, alanine aminotransferase 192IU/mL and alkaline phosphatase 299IU/mL. All 17 patients died or required re-LT a mean of 7.8months after the FCH diagnosis. Conclusion: FCH occurs infrequently and is typified by hyperbilirubinemia, donor age of more than 50years, extremely high HCV RNA and specific histological changes occurring within the first several months post-LT with extremely poor patient and graft survival. Histology alone is not reliable for the diagnosis of FCH, especially in the setting of recurrent HCV with concurrent biliary problems.

Original languageEnglish (US)
Pages (from-to)328-339
Number of pages12
JournalHepatology Research
Volume41
Issue number4
DOIs
StatePublished - Apr 2011
Externally publishedYes

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Hepatitis C
Liver Transplantation
Hepacivirus
Tissue Donors
Hyperbilirubinemia
Cholestasis
Graft Survival
Aspartate Aminotransferases
Viral Load
Alanine Transaminase
Bilirubin
Alkaline Phosphatase
Histology
Databases
RNA
Pathology
Inflammation
Biopsy
Incidence

All Science Journal Classification (ASJC) codes

  • Hepatology
  • Infectious Diseases

Cite this

Clinical characterization of patients developing histologically-proven fibrosing cholestatic hepatitis C post-liver transplantation. / Satapathy, Sanjaya; Sclair, Seth; Fiel, M. Isabel; Del Rio Martin, Juan; Schiano, Thomas.

In: Hepatology Research, Vol. 41, No. 4, 04.2011, p. 328-339.

Research output: Contribution to journalArticle

Satapathy, Sanjaya ; Sclair, Seth ; Fiel, M. Isabel ; Del Rio Martin, Juan ; Schiano, Thomas. / Clinical characterization of patients developing histologically-proven fibrosing cholestatic hepatitis C post-liver transplantation. In: Hepatology Research. 2011 ; Vol. 41, No. 4. pp. 328-339.
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abstract = "Aim: Fibrosing cholestatic hepatitis C (FCH) post-liver transplantation (LT) is an uncommon disorder with extremely poor outcome. Using stringent histological criteria, we sought to identify cases of FCH to better characterize its incidence, clinical features and outcomes. Methods: From January 1991 to December 2007, 973 LT for hepatitis C virus (HCV) were performed at our center. Using the pathology database, 51 cases with a provisional diagnosis of FCH were identified. FCH was diagnosed histologically by cholestasis accompanied by thin periportal fibrous septa, ductular reaction and mild inflammation. Results: FCH was reconfirmed in 24 recipients; seven had concurrent biliary problems. Twenty-seven cases were excluded; biopsy was unavailable in nine cases, 15 did not meet the histological criteria of FCH and three had missing clinical information. All received deceased donors at a mean age of 64.4years (15/17 aged >50years). Mean time from LT to FCH was 7.6months with 16 of 17 diagnosed within 1year of LT. At diagnosis, mean viral load was 14.4million IU/mL, bilirubin 16.2mg/dL, aspartate aminotransferase 262IU/mL, alanine aminotransferase 192IU/mL and alkaline phosphatase 299IU/mL. All 17 patients died or required re-LT a mean of 7.8months after the FCH diagnosis. Conclusion: FCH occurs infrequently and is typified by hyperbilirubinemia, donor age of more than 50years, extremely high HCV RNA and specific histological changes occurring within the first several months post-LT with extremely poor patient and graft survival. Histology alone is not reliable for the diagnosis of FCH, especially in the setting of recurrent HCV with concurrent biliary problems.",
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N2 - Aim: Fibrosing cholestatic hepatitis C (FCH) post-liver transplantation (LT) is an uncommon disorder with extremely poor outcome. Using stringent histological criteria, we sought to identify cases of FCH to better characterize its incidence, clinical features and outcomes. Methods: From January 1991 to December 2007, 973 LT for hepatitis C virus (HCV) were performed at our center. Using the pathology database, 51 cases with a provisional diagnosis of FCH were identified. FCH was diagnosed histologically by cholestasis accompanied by thin periportal fibrous septa, ductular reaction and mild inflammation. Results: FCH was reconfirmed in 24 recipients; seven had concurrent biliary problems. Twenty-seven cases were excluded; biopsy was unavailable in nine cases, 15 did not meet the histological criteria of FCH and three had missing clinical information. All received deceased donors at a mean age of 64.4years (15/17 aged >50years). Mean time from LT to FCH was 7.6months with 16 of 17 diagnosed within 1year of LT. At diagnosis, mean viral load was 14.4million IU/mL, bilirubin 16.2mg/dL, aspartate aminotransferase 262IU/mL, alanine aminotransferase 192IU/mL and alkaline phosphatase 299IU/mL. All 17 patients died or required re-LT a mean of 7.8months after the FCH diagnosis. Conclusion: FCH occurs infrequently and is typified by hyperbilirubinemia, donor age of more than 50years, extremely high HCV RNA and specific histological changes occurring within the first several months post-LT with extremely poor patient and graft survival. Histology alone is not reliable for the diagnosis of FCH, especially in the setting of recurrent HCV with concurrent biliary problems.

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