Fulminant hepatic failure in a renal transplant recipient with positive hepatitis B surface antigens: A case report of fibrosing cholestatic hepatitis

This 28-year-old male, a hepatitis B virus (HBV) carrier, received cadaveric renal transplantation and was maintained on cyclosporin A and prednisolone. Jaundice occurred 8 months after the transplantation and he dies 2 weeks later due to hepatic failure. The liver histologic findings were compatible with fibrosing cholestatic hepatitis (FCH), which is caused by HBV and has only been reported in liver allografts of orthotopic liver transplantations. This is the first case of FCH developing in a renal transplant recipient. The report illustrates that (1) is also a unique histologic entity in renal transplantations; (2) FCH might occur in a liver chronically infected by HBV without co-existing hepatitis D virus; and (3) FCH can cause fulminant hepatic failure within one year after transplantation while the patient is still in an immunosuppressed state.