O. Pappo et al., RECURRENT AND DE-NOVO GIANT-CELL HEPATITIS AFTER ORTHOTOPIC LIVER-TRANSPLANTATION, The American journal of surgical pathology, 18(8), 1994, pp. 804-813
This study examines the clinical and pathologic course of seven patien
ts who developed giant cell hepatitis (GCH) after liver transplantatio
n. Five of these patients also had GCH as their native liver disease a
nd experienced a particularly aggressive course because of recurrent d
isease, beginning 1-21 months after transplantation. Two died and anot
her two required hepatic retransplantation because of recurrent GCH; o
ne of them had GCH rerecurrence in a second liver allograft. A remaini
ng patient with recurrent GCH is alive 6 years after transplantation.
Follow-up of the two patients who developed de novo GCH between 8 and
24 months after hepatic transplantation showed active micronodular cir
rhosis in one and persistent giant cell transformation in the other at
4 years. All of the patients were serologically negative for hepatiti
s C virus, hepatitis B virus, and human immunodeficiency virus before
transplantation. One patient became positive for hepatitis C virus aft
er transplantation. Two patients had an associated autoimmune syndrome
, which could have been accounted for by the GCH. None had a history o
f drug exposure. Interestingly, human papilloma virus (HPV) type 6 was
detected by PCR analysis of liver tissues with GCH from one of three
cases before and three of four cases after transplantation. This small
series shows that GCH occurs in liver allografts, but it is uncommon.
Documentation of recurrent disease in five of seven patients suggests
that GCH in a subgroup of patients may be related to a transmissible
agent, or that a particular recipient may injure livers in a way that
elicits a giant cell reaction.