Saraf Neeraj, Fiel M Isabel, Deboccardo Graciela, Emre Sukru, Schiano Thomas D
Mount Sinai Medical Center Division of Liver Diseases, New York, NY 10029, USA.
Liver Transpl. 2007 Jun;13(6):913-7. doi: 10.1002/lt.21188.
Early histological recurrence of hepatitis C after liver transplantation (LT) has a negative impact on patient and graft survival. We report a case of histological recurrence of HCV occurring in the second week after LT. A 75-year-old woman with chronic HCV and hepatocellular carcinoma underwent LT with an organ from a 75-year-old HCV-negative deceased donor. After an uneventful early postoperative period, an increase in the transaminases was observed, and on postoperative day 9 day, the alanine aminotransferase (ALT) was 673 IU/mL and aspartate aminotransferase (AST) 300 IU/mL, with normal alkaline phosphatase and bilirubin. Analysis of liver biopsy samples showed diffuse necroinflammatory changes with acidophilic bodies and concomitant mild acute cellular rejection. Subsequently there was a further increase in the transaminases, and on postoperative day 13, the AST rose to 445 IU/mL and ALT to 992 IU/mL. Repeat biopsy was performed, and analysis of the samples revealed lymphocytic portal inflammation with lymphoid aggregates and mild interface hepatitis, parenchymal necrosis, activation of sinusoidal lining cells, and mild steatosis. The biopsy sample was characteristic for HCV recurrence. The HCV RNA level was 84,000,000 copies/mL, and markers for other viral causes were not present. The patient became jaundiced and her course progressively worsened. She died on day 87 after transplantation. To our knowledge, this is the earliest reported case of histological recurrence of HCV after LT. It illustrates the importance of older donor and recipient age in the same patient as cofactors for early HCV recurrence and poor outcome.
肝移植（LT）后丙型肝炎的早期组织学复发对患者和移植物存活有负面影响。我们报告1例肝移植后第2周发生丙型肝炎病毒（HCV）组织学复发的病例。1名患有慢性HCV和肝细胞癌的75岁女性接受了来自1名75岁HCV阴性脑死亡供者器官的肝移植。术后早期过程顺利，之后观察到转氨酶升高，术后第9天，丙氨酸转氨酶（ALT）为673 IU/mL，天冬氨酸转氨酶（AST）为300 IU/mL，碱性磷酸酶和胆红素正常。肝活检样本分析显示有嗜酸性小体的弥漫性坏死性炎症改变，并伴有轻度急性细胞排斥反应。随后转氨酶进一步升高，术后第13天，AST升至445 IU/mL，ALT升至992 IU/mL。再次进行活检，样本分析显示淋巴细胞性门管区炎症伴淋巴滤泡形成及轻度界面性肝炎、实质坏死、肝血窦内皮细胞活化和轻度脂肪变性。活检样本具有HCV复发的特征。HCV RNA水平为84,000,000拷贝/mL，未检测到其他病毒病因的标志物。患者出现黄疸，病情逐渐恶化。她在移植后第87天死亡。据我们所知，这是肝移植后HCV组织学复发报道最早的病例。它说明了同一患者中供者和受者年龄较大作为早期HCV复发和不良预后的辅助因素的重要性。
