Fatal acute hepatic failure with hepatocarcinoma presentation in a renal transplant with asymptomatic chronic B and C hepatitis.

Fatal acute hepatic failure with hepatocarcinoma presentation in a renal tr ansplant with asymptomatic chronic B and C hepatitis. Hepatocellular carcin oma is a primary tumor complicating liver disease, associated with cirrhosi s in 80-90% of the cases. A kidney transplant recipient with chronic B and C viral hepatitis was admitted because of general malaise, renal function i mpairment and positive AST, ALT and alkaline phosphatase tests, and very hi gh alpha -phetoprotein levels. Ascites, spontaneous bacterial peritonitis a nd renal failure developed. A CT showed multiple liver masses. Renal failur e required hemodialysis. The patient died 17 days after the initial symptom s with hepatic encephalopathy. A postmortem liver biopsy confirmed the diag nosis of cirrhosis and hepatocellular carcinoma (HCC). This report, as well as a few others, shows the accelerated evolution of chronic viral hepatiti s in kidney transplant patients and questions the convenience of kidney tra nsplantation and the adequate follow up in chronic viral hepatitis.