Hyperbilirubinemia and cholestatic liver injury in hepatitis C-infected liver transplant recipients

OBJECTIVE: A cholestatic pattern of liver injury has been observed in liver transplant recipients with rapidly progressive hepatitis C. We assessed th e frequency and causes of cholestasis in hepatitis C-infected liver transpl ant patients, and evaluated the clinical and pathological course of those w ith cholestatic hepatitis C. METHODS: Sixty-nine sequential liver transplant recipients who had detectab le hepatitis C viremia were studied retrospectively. Records and diagnostic tests were examined from patients who developed hyperbilirubinemia. RESULTS: Hyperbilirubinemia occurred in 33 of 69 (48%) hepatitis C-infected liver transplant patients. A thorough evaluation including review of clini cal and laboratory data, ultrasound with Doppler, cholangiogram, and liver biopsy identified causes of hyperbilirubinemia other than hepatitis C in 26 of 33 patients. Seven patients developed cholestatic hepatitis C character ized by histological features of recurrent hepatitis C and cholestatic live r injury with ballooning of centrilobular hepatocytes, bile ductular prolif eration, and canalicular cholestasis, in the absence of other causes of cho lestasis. Five progressed rapidly to bridging fibrosis and two died of comp lications related to liver failure. Four patients with cholestatic hepatiti s C showed extended survival after the onset of hyperbilirubinemia. CONCLUSIONS: 1) Hepatitis C is a relatively infrequent cause of cholestasis in liver transplant recipients. 2) The diagnosis of cholestatic hepatitis C requires a multimodality approach to exclude other causes of cholestasis. 3) Cholestatic hepatitis C ranges in severity and is not always associated with rapid development of graft failure, although significant histological abnormalities are frequent. (Am J Gastroenterol 2000;95:753-759. (C) 2000 by Am. Cell. of Gastroenterology).