CLINICAL AND HISTOLOGIC PATTERNS OF EARLY GRAFT FAILURE DUE TO RECURRENT HEPATITIS-C IN 4 PATIENTS AFTER LIVER-TRANSPLANTATION

Hepatitis C viral recurrence after orthotopic liver transplantation is almost universal. Hepatitis C-induced graft failure may occur, but th e clinical and histologic profiles are not well defined. The aim of th is study was to describe the pattern of early graft failure in patient s with recurrent hepatitis C after liver transplantation. Thirty patie nts with hepatitis C underwent liver transplantation from October 1989 through September 1994, Four patients were excluded because of death (2 patients), graft failure unrelated to hepatitis C (1 patient), and lost to follow-up (1 patient), Hepatitis C recurred in 24 of the 26 re maining patients, In 4 patients with hepatitis C virus recurrence and cholestasis, graft failure developed at 5.25, 11.0, 11.0, and 18.5 mon ths, The medical records and liver biopsies were reviewed. In all 4 pa tients, a histologic pattern characterized by centrilobular ballooning degeneration developed and progressed to involve more than two-thirds of the lobules, Moderate to severe cholestasis and bridging fibrosis were present in all grafts at explant. Two patients had portal inflamm ation on 3-month biopsies consistent with viral hepatitis, AU patients had mild macrovesicular steatosis, but only 1 patient had significant lymphoid aggregates, No patient had evidence of hepatic artery thromb osis, One patient had potential drug-induced cholestasis. One patient had 3 episodes of rejection that were not believed to contribute to gr aft loss, All 4 patients developed clinical features of hepatic failur e and were retransplanted. Two patients had early recurrence of graft failure. We conclude that a pattern of progressive centrilobular ballo oning degeneration, bridging fibrosis, and cholestasis occurs in some patients with hepatitis C with early graft failure, similar to fibrosi ng cholestatic hepatitis seen in some transplant patients with recurre nt hepatitis B.