CRYOGLOBULINEMIA PRESENTING AFTER LIVER-TRANSPLANTATION

Essential mixed cryoglobulinemia is frequently associated with chronic hepatitis C. Three patients undergoing transplantation for end-stage chronic hepatitis C in whom cryoglobulinemia with vasculitis developed after transplantation are described. Hepatitis C virus (HCV) infectio n was confirmed in the 3 patients by the presence of HCV RNA detected by polymerase chain reaction. The time interval between transplantatio n and the first expression of vasculitis was 1, 5, and 17 months, Type II cryoglobulins were detected in the sera of all 3 patients. All pat ients developed cutaneous vasculitis, requiring digital amputation in 1 case. Two patients developed membranoproliferative glomerulonephriti s, Plasmapheresis and the addition of cyclophosphamide led to an impro vement in the renal disease in 1 case, whereas no treatment was able t o reverse the renal failure in the other case. One patient developed a n autoimmune hemolytic anemia 4 years after transplantation, One patie nt died of multiorgan failure 5 months after transplantation. We propo se that HCV-associated cryoglobulinemia could become clinically signif icant only after orthotopic liver transplantation, possibly due in par t to posttransplant increase in viremia as reflected by HCV RNA levels , These results confirm previous observations suggesting that HCV infe ction is important etiologically in the pathogenesis of cryoglobulinem ia.