Toth C M, Pascual M, Chung R T, Graeme-Cook F, Dienstag J L, Bhan A K, Cosimi A B
Transplantation Unit, Massachusetts General Hospital, and Harvard Medical School, Boston 02114, USA.
Transplantation. 1998 Nov 15;66(9):1254-8. doi: 10.1097/00007890-199811150-00023.
Fibrosing cholestatic hepatitis (FCH) has recently been described after solid organ transplantation in patients with hepatitis C virus (HCV) infection. Typically, FCH is characterized by an ominous clinical course leading to progressive hepatic failure and death if liver transplantation is not performed. Two HCV-infected patients underwent cadaveric renal transplantation for end-stage renal disease resulting from membranous nephropathy and diabetic nephropathy. The time intervals between transplantation and the biopsy diagnosis of FCH for the two patients were 7 months and 10 years. Both patients presented with jaundice, hyperbilirubinemia, and mild-to-moderate elevations in serum aspartate aminotransferase. One patient was also found to have type II mixed cryoglobulinemia. Interferon-alpha therapy was begun after a diagnosis of FCH was established by liver biopsy. Liver test abnormalities normalized rapidly. When cholestatic hepatic deterioration develops in an HCV-infected organ allograft recipient, the diagnosis of FCH should be considered and a liver biopsy performed. Our observations indicate that FCH can respond to antiviral therapy.
纤维化淤胆型肝炎（FCH）最近在丙型肝炎病毒（HCV）感染的实体器官移植患者中被描述。典型地，FCH的特征是临床病程凶险，如果不进行肝移植，会导致进行性肝衰竭和死亡。两名HCV感染患者因膜性肾病和糖尿病肾病导致的终末期肾病接受了尸体肾移植。两名患者从移植到FCH活检诊断的时间间隔分别为7个月和10年。两名患者均出现黄疸、高胆红素血症，血清天冬氨酸转氨酶轻度至中度升高。其中一名患者还被发现患有II型混合性冷球蛋白血症。在肝活检确诊FCH后开始使用α干扰素治疗。肝功能检查异常迅速恢复正常。当HCV感染的器官移植受者出现淤胆性肝脏恶化时，应考虑FCH的诊断并进行肝活检。我们的观察表明，FCH对抗病毒治疗有反应。
