Fibrosing Cholestatic Hepatitis after Liver Transplantation in a Patient with Hepatitis C and HIV Infection

Abstract

A small but growing number of patients with human immunodeficiency virus (HIV) infection undergo orthotopic liver transplantation for complications of intercurrent infection with hepatitis B virus (HBV), hepatitis C virus (HCV), or both. HCV invariably reinfects liver allografts, typically causing a lobular hepatitis, and is reasonably well tolerated in the short term. If hepatitis B recurs after transplantation, it frequently causes devastating disease characterized by a rapidly progressive pathological process termed fibrosing cholestatic hepatitis, resulting in liver failure.¹ The postulated mechanism of this process is unimpeded viral replication mediated by immunosuppression in the transplant recipient. HIV has been shown to cause fibrosing cholestatic hepatitis in combination with HBV infection.^2,3 We report on a patient with HIV in whom fibrosing cholestatic hepatitis developed after liver transplantation for HCV infection, in the absence of HBV coinfection.