Cholestatic Hepatitis C in Immunocompromised Settings

The hepatitis C virus (HCV) is a major public health concern and a leading cause of chronic liver disease and liver transplantation. If the virus is not eradicated before liver transplantation, HCV infection recurs in almost all patients. Recurrent HCV after liver transplantation has a variable clinical course. Rarely, a severe cholestatic form of recurrent HCV can occur, better known as fibrosing cholestatic hepatitis (FCH). This type of cholestasis can lead to fibrosis and graft dysfunction in an accelerated fashion and is associated with a high morbidity and mortality. It has been described in other organ transplant recipients and patients with HIV/HCV coinfection, suggesting that an immunocompromised state is necessary to develop FCH.