Hepatitis C virus (HCV)-related cryoglobulinemia after liver transplantation for HCV cirrhosis

Abstract

The aim of this study was to analyze the clinical impact of hepatitis C virus (HCV)-related cryoglobulinemia in patients that had received liver transplants after HCV cirrhosis. Thirty patients who had received transplants between 1990 and 1996 for HCV cirrhosis and who had a follow-up longer than 1 year were studied. Serum HCV RNA levels, HCV genotype, cryoglobulinemia, rheumatoid factor, serum C3 and C4, IgA, IgG, IgM levels, liver tests, and liver histology were studied 30 + 16 months post-transplant. Cryoglobulinemia was found in 9 of 30 patients (30.0%) and was symptomatic in 4 of the 9 cases (glomerulonephritis, 1 case; palpable purpura, 3 cases). Age, sex distribution, alanine aminotransferase (ALAT) activity, and Knodell score did not differ, whether cryoglobulinemia was present or not. Rheumatoid factor (209.5 + 70.4 IU/l vs 12.0 + 4.4 IUjl, P = 0.004) and IgM levels (3.2k0.5 g/1 vs 1.6*0.9 g/l, P = 0.0001) were significantly higher, and C4 levels (0.16 f. 0.16 g/1 vs 0.30+0.10 g/l, P=O.O09) were significantly lower in patients with cryoglobulinemia. One patient died from cryoglobulin-related renal failure. We concluded that, after liver transplantation (LT) for HCV cirrhosis, cryoglobulinemia was frequent and often symptomatic. Cryoglobulinemia did not seem to be associated with more severe graft damage. Cryoglobulinemiaassociated morbidity must be taken into account in the management of post-transplant HCV infection.

Nontumoral dermatologic problems after liver transplantation

“…Numerous dermatological manifestations have been linked to chronic hepatitis C; this is convincingly the case for vasculitis due to mixed cryoglobulinemia, porphyria cutanea tarda and lichen planus 25. In a series of 30 patients transplanted for chronic hepatitis C–induced cirrhosis, 9 had detectable cryoglobulinemia after transplantation that was symptomatic in 4 cases (3 palpable purpuras and 1 glomerulonephritis) 26. In another series, based on 31 patients transplanted for the same indication, 6 developed mixed cryoglobulins and 2 developed purpura 27.…”

Immunosuppression in liver transplant recipients with renal impairment

“…In patients with HCV recurrence, it is assumed that renal deterioration is accelerated by latent membranoproliferative glomerulonephritis often pre-existing LT [83] or detected post-LT [84]. This results in a higher incidence of significant proteinuria in HCV + compared to HCV-LT recipients [85].…”

Treatment With Pegylated Interferon and Ribavirin for Hepatitis C Virus-associated Severe Cryoglobulinemia in a Liver/Kidney Transplant Recipient

“…These manifestations may also recur after transplantation. 7 Severe flares of cryoglobulinemic vasculitis leading to amputations, kidney failure, and death have been reported after liver transplantation, possibly because of the higher viral loads associated with posttransplant immunosuppression. 8,9 The development of effective strategies to prevent HCV recurrence and/or to limit its clinical consequences is currently a major focus for transplant medicine.…”