SEVERE RECURRENT CHOLESTATIC HEPATITIS-C FOLLOWING ORTHOTOPIC LIVER-TRANSPLANTATION

Recurrent infection with hepatitis C virus (HCV) is almost universal f ollowing orthotopic liver transplantation although clinical severity v aries, Data on 135 patients who underwent transplantation for hepatiti s C cirrhosis were reviewed, We describe a progressive, severe cholest atic form of hepatitis occurring in a subgroup of patients with recurr ent hepatitis C. Ten patients with severe recurrent hepatitis C were i dentified; 1 has died, 1 awaits retransplantation, and 8 have undergon e retransplantation, All 10 developed severe progressive cholestatic h epatitis, with a mean rise in bilirubin to 24.7 mg/dL at the time of r etransplantation, Histology at initial recurrence was of mild hepatiti s without evidence of rejection, The failed grafts showed either cirrh osis or confluent hepatic necrosis, The onset of cholestasis preceded retransplantation by less than 5 months, Our study suggests that a min ority of patients with recurrent hepatitis C after undergoing liver tr ansplantation develop a severe progressive cholestatic hepatitis and l iver failure.