Murakami K, Kawagishi N, Ishida K, Sekiguchi S, Fujishima F, Sasano H, Ohuchi N
Division of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Sendai, Japan.
Division of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Sendai, Japan.
Transplant Proc. 2014 Apr;46(3):995-8. doi: 10.1016/j.transproceed.2013.09.047.
Fibrosing cholestatic hepatitis (FCH) is a life-threatening consequence of hepatitis C virus (HCV) infection occurring in a small minority of liver transplantation (LT) recipients. We herein report a case of early-onset FCH after living donor LT in a 47-year-old woman with HCV-related cirrhosis. The patient underwent balloon-occluded retrograde transvenous obliteration of a splenorenal shunt to treat an impaired portal flow on the sixth postoperative day (POD 6) and a bypass operation for hepatic artery thrombosis on POD 12. Thereafter, the serum bilirubin levels increased gradually; however, computed tomography revealed no evidence of biliary stricture. The serum HCV-RNA level on POD 27 was >7.8 log IU/mL. Histopathology of a needle graft biopsy performed on POD 28 revealed FCH with extensive portal fibrosis accompanied by mild inflammation, hepatocyte ballooning, and ductular proliferation with cholestasis. The patient received combination therapy with pegylated interferon, ribavirin, and double-filtration plasmapheresis for the treatment of early-onset FCH. Both the recipient and the donor carried the major genotype single nucleotide polymorphism (TT) at rs8099917 near the interleukin-28B gene. Furthermore, the HCV genotype was treatment-sensitive 2a. Nonetheless, the recipient died of hepatic failure on POD 211. Thus far, few cases of FCH occurring within 1 month after LT have been reported. In addition, the early onset of FCH may be an adverse prognostic factor.
纤维化淤胆型肝炎（FCH）是丙型肝炎病毒（HCV）感染的一种危及生命的后果，发生于少数肝移植（LT）受者中。我们在此报告一例47岁患有HCV相关肝硬化的女性活体肝移植后早期发生FCH的病例。患者在术后第6天（POD 6）接受了球囊闭塞逆行静脉脾肾分流术以治疗门静脉血流受损，并在POD 12接受了肝动脉血栓形成的搭桥手术。此后，血清胆红素水平逐渐升高；然而，计算机断层扫描未发现胆管狭窄的证据。POD 27时血清HCV-RNA水平>7.8 log IU/mL。POD 28进行的针吸移植活检组织病理学显示为FCH，伴有广泛的门脉纤维化，伴有轻度炎症、肝细胞气球样变以及胆管增生伴胆汁淤积。患者接受了聚乙二醇干扰素、利巴韦林和双重过滤血浆置换的联合治疗以治疗早期发生的FCH。受者和供者在白细胞介素-28B基因附近的rs8099917均携带主要基因型单核苷酸多态性（TT）。此外，HCV基因型为对治疗敏感的2a型。尽管如此，受者在POD 211死于肝衰竭。迄今为止，很少有关于LT后1个月内发生FCH的病例报道。此外，FCH的早期发生可能是一个不良预后因素。
