Liver Transplantation - 17

<html>  <HEAD><title>Liver Transplant - Case 17</title></HEAD> <body bgcolor=#ffffff link="darkblue" vlink="006666"> <IMG SRC="/tpis/icons/purpball.gif"> <i>Contributed by Anthony J. Demetris, M.D.</A></i> <HR> <b>PATIENT HISTORY:</b> Per referral letter, the patient is a 53-year-old black male who underwent liver transplantation on 1/6/96 for acute fulminant liver failure due to Budd-Chiari syndrome. De novo post transplant hepatitis C was diagnosed in February, 1996 by HCV RNA in serum and liver tissues and a consistent histopathological features. His aminotransferases and total bilirubin were persistently elevated between 1-2 times normal until early November when the total bilirubin and alkaline phosphatase were noted to be 5 times normal. Itaconazole, started about 2-3 weeks earlier for dermatophytosis, was discontinued due to presumed hepatotoxicity. His other medications were cyclosporine A, prednisone, coumadin, and axid. Subsequently, the patient developed a progressive rise in AST, ALT and total bilirubin to 700-900, 1200-2100 and 25-30 mg/dl. He has been on anticoagulant therapy and recent ultrasound with Doppler flow studies indicate that all hepatic vessels are patent. An ERCP was normal. A CT scan of the abdomen showed ascites, but no mass or lymphadenopathy. All viral studies (HAV, HBV, CMV, EBV) have been negative. Serum HCV RNA levels have not changed compared to 7/96 when his condition was stable. A qualitative EBV PCR was positive but EBV DNA was undetectable by a quantitative assay (done at the University of Pittsburgh). An EBER in situ hybridization study was equivocal, but since B cells were uncommon in the liver infiltrate post transplant lymphoproliferative disorder is unlikely. He has had several liver biopsies which showed chronic hepatitis, more recently with cirrhosis and features of acute hepatitis. Despite 2 weeks of interferon for possible hepatitis C and empiric ganciclovir (?EBV), his condition has not improved. The patient now has ascites, hepatic encephalopathy, hypoalbuminemia, and renal failure. Review of outside material. <hr> <A HREF="GH00043.html">GROSS DESCRIPTION</a><P> <A HREF="/tpis/images/H00043a.jpg"><IMG SRC="/tpis/images/tnails/H00043a.jpg" width=133 height=100></a> <A HREF="/tpis/images/H00043b.jpg"><IMG SRC="/tpis/images/tnails/H00043b.jpg" width=133 height=100></a> <A HREF="/tpis/images/H00043c.jpg"><IMG SRC="/tpis/images/tnails/H00043c.jpg" width=133 height=100></a> <A HREF="/tpis/images/H00043d.jpg"><IMG SRC="/tpis/images/tnails/H00043d.jpg" width=133 height=100></a> <A HREF="/tpis/images/H00043e.jpg"><IMG SRC="/tpis/images/tnails/H00043e.jpg" width=133 height=100></a> <A HREF="/tpis/images/H00043f.jpg"><IMG SRC="/tpis/images/tnails/H00043f.jpg" width=133 height=100></a> <A HREF="/tpis/images/H00043g.jpg"><IMG SRC="/tpis/images/tnails/H00043g.jpg" width=133 height=100></a> <A HREF="/tpis/images/H00043h.jpg"><IMG SRC="/tpis/images/tnails/H00043h.jpg" width=133 height=100></a> <A HREF="/tpis/images/H00043i.jpg"><IMG SRC="/tpis/images/tnails/H00043i.jpg" width=133 height=100></a> <A HREF="/tpis/images/H00043j.jpg"><IMG SRC="/tpis/images/tnails/H00043j.jpg" width=133 height=100></a> <A HREF="/tpis/images/H00043k.jpg"><IMG SRC="/tpis/images/tnails/H00043k.jpg" width=133 height=100></a> <A HREF="/tpis/images/H00043l.jpg"><IMG SRC="/tpis/images/tnails/H00043l.jpg" width=133 height=100></a> <P> <A HREF="MH00043.html">MICROSCOPIC DESCRIPTION</a><P> <A HREF="XH00043.html">FINAL DIAGNOSIS</a><P>  <hr> <font size=3> Please mail comments, corrections or suggestions to the <a href="mailto:harperth@upmc.edu"> <i>TPIS administration</i></a> at the UPMC.<p> This page and its contents are Copyright © 1996, 1997 <A HREF="http://www.upmc.com/Pages/default.aspx">University of Pittsburgh</a>. All rights reserved. Unauthorized redistribution prohibited.<p> <CENTER> <a href="/tpislibrary/index.html" target="_top">[FRAMES]</a> <a href="/tpislibrary/casedata/H00043/index.html" target="_top">[NO FRAMES]</a> </font> </CENTER> </body> </html>