Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
Surg Today. 2010 Oct;40(10):982-5. doi: 10.1007/s00595-009-4168-5. Epub 2010 Sep 25.
Cholestatic hepatitis is a life-threatening recurrent pattern of hepatitis C virus (HCV) in immunosuppressed patients, for which curative treatment has not yet been established. We report the successful treatment of cholestatic hepatitis in a 59-year-old man who had undergone right lobe living donor liver transplantation (LDLT) for liver cirrhosis (LC) caused by HCV. Following uneventful surgery and an uncomplicated posttransplant clinical course, there was an abrupt increase in total bilirubin in comparison to aminotransferase on postoperative day (POD) 60 (total bilirubin 16.2 mg/dl, alanine aminotransferase 100 U/l, HCV-RNA 390 kIU/ml). The histological findings of the liver tissue showed lymphocyte infiltration in the periportal zone and severe cholestasis. Considering the clinical course, cholestatic hepatitis was strongly suspected and pegylated interferon and ribavirin therapy was started immediately, resulting in not only a viral response, but minimal progression of fibrosis. This case serves to demonstrate that early diagnosis and timely initiation of optimal antiviral therapy is essential for the resolution of cholestatic hepatitis C.
胆汁淤积性肝炎是一种危及生命的丙型肝炎病毒（HCV）在免疫抑制患者中的反复发作模式，目前尚未确立其治愈性治疗方法。我们报告了一例成功治疗由 HCV 引起的肝硬化（LC）的 59 岁男性患者的胆汁淤积性肝炎。该患者行右半肝活体肝移植（LDLT）后，手术顺利，移植后临床过程无并发症，但在术后第 60 天（总胆红素 16.2mg/dl，丙氨酸氨基转移酶 100U/l，HCV-RNA390kIU/ml）与转氨酶相比，总胆红素突然升高。肝组织的组织学检查显示门脉周围区淋巴细胞浸润和严重的胆汁淤积。根据临床经过，强烈怀疑为胆汁淤积性肝炎，并立即开始使用聚乙二醇干扰素和利巴韦林治疗，不仅病毒得到了应答，而且纤维化也得到了最小程度的进展。该病例表明，早期诊断和及时开始最佳抗病毒治疗对于解决丙型肝炎的胆汁淤积是至关重要的。
