Posttransplant Liver Granulomatosis Associated With Hepatitis C?1

Abstract

We think that HCV can be listed among the possible causes of liver granulomas in the posttransplant setting and that it must be considered in the differential diagnosis of this condition.

Disease recurrence after living liver transplantation for primary biliary cirrhosis: A clinical and histological follow-up study

“…Even the presence of granulomatous cholangitis has been reported in a rare case of rejection, 26 although most investigators appear never to have seen that. To complicate matters, granulomatous cholangitis, generally considered the hallmark of PBC, sometimes was found in recurrent hepatitis C 27 or a granulomatous lesion may be absent in PBC, particularly if only small samples can be reviewed. In our patients 1 and 3, both recurrent PBC and rejection were diagnosed based on histological findings (portal granulomas and central vein endotheliitis) and the failure of steroid therapy in patient 1 and the effectiveness of UCDA therapy in patient 3 (decrease in aminotransferase and alkaline phosphatase values).…”

Development of hepatic granulomas in patients receiving pegylated interferon therapy for recurrent hepatitis C virus post liver transplantation

“…These reports vary as to whether the presence of hepatic granulomas suggests a negative or favorable outcome. Three patients found to have granulomas on liver biopsy either responded poorly to treatment or not at all (21) and in 1 case the discovery of granulomas coincided with a viral flare (34). Others have found that granulomas are predictive of a favorable response (10).…”

“…Others have found that granulomas are predictive of a favorable response (10). Rare case reports of post‐LT HCV patients receiving interferon therapy developing granulomas are found in the literature (34–36). Granulomas may develop because interferon‐α is an immunomodulator that enhances the T H 1 cell‐mediated immune response.…”