POSTTRANSPLANTATION CHRONIC HEPATITIS IN FULMINANT HEPATIC-FAILURE

Non-A, non-B or seronegative hepatitis is the leading indication for l iver transplantation in patients with fulminant hepatic failure (FHF). We examined protocol annual review liver allograft biopsy specimens i n consecutive adult patients transplanted for FHF in an attempt to det ermine the extent of the histological changes. One hundred eleven biop sy specimens from 41 patients transplanted for fulminant seronegative hepatitis and 34 from a comparison group of 16 patients transplanted f or other causes of FHF (11 paracetamol overdose, 2 idiosyncratic drug reaction, 3 Wilson's disease) were available. Specimens were analyzed using standard proforma without knowledge of the original diagnosis. C hronic hepatitis was present in 29 patients (71% ) transplanted for fu lminant seronegative hepatitis (23 mild, 3 moderate, and 3 severe) com pared with 5 patients (31%, all mild) transplanted for other causes of FHF. Twenty-five patients (61%) grafted for seronegative FHF had fibr osis (13 mild, 9 moderate, and 3 severe) in contrast to 4 fibrosis (25 %) (all mild) in the comparison group. Excluding early allograft failu re because of primary graft nonfunction or vascular complications, six patients with seronegative FHF required retransplantation (2 = chroni c rejection; 1 = severe hepatitis with panacinar necrosis, resembling original liver; and 3 = chronic hepatitis with precirrhotic fibrosis a nd prominent cholestasis of unknown cause). One patient in the compari son group had a second graft (chronic rejection). Posttransplantation chronic hepatitis is more frequent and severe in patients transplanted for seronegative hepatitis. Graft survival may be adversely influence d by the development of chronic hepatitis, which may represent persist ent or recurrent disease.