The Patient Facing Fibrosing Cholestatic Hepatitis

This flow traces the rare but life-threatening posttransplant course of rapidly progressive cholestatic HCV disease.

increasingBearing stren­gth in each eventdecreasing

Viral Amplification

Viral Amplification Immunosuppression removes restraint After transplantation, HCV replication may increase sharply under powerful immunosuppression. Most patients do not develop catastrophic disease, but a vulnerable minority enter a rapidly worsening course. The warning pattern Cholestasis, rising bilirubin, alkaline phosphatase elevation, and high HCV RNA signal a process more dangerous than ordinary recurrent hepatitis.

Cholestatic Crisis

Cholestatic Crisis Fibrosis without warning Fibrosing cholestatic hepatitis may present with severe cholestasis but only mild aminotransferase abnormalities. Liver biopsy reveals diffuse fibrosis, leukocyte infiltration, and cholestatic injury. Rapid failure The disease can progress to subfulminant Liver failure, sepsis, and death. Its intensity makes ordinary surveillance insufficient once the biochemical pattern appears.

Emergency Antiviral Decision

Emergency Antiviral Decision A dangerous exception Although interferon is usually avoided after kidney transplantation, life-threatening cholestatic disease may justify it. Immunosuppression may also need drastic reduction. Survival against graft risk The patient must accept possible rejection or graft loss in order to control an otherwise fatal liver process. The conflict becomes a direct choice between preserving the graft and preserving life.

early after Kidney transplantation

one to twelve months after transplantation

after biopsy confirmation