Rapidly Progressing Cholestatic Liver Failure After Allogeneic Stem Cell Transplant from Hepatitis C Virus-Positive Donor (FCHCV)

  • Keith R. Loeb
  • Howard M. ShulmanEmail author


There are several different liver disorders which may occur concurrently post-HSCT. This chapter covers the history of hepatitis C virus (HCV) before the development of direct-acting antiviral therapy. The case discusses an HCV-negative patient who received a transplant from his HCV-positive donor. The patient had well-established hepatic GVHD but later developed a rapid rise in his aminotransferases coupled with a rapid rise in his HCV viral copy number. The pathology of fibrosing cholestatic hepatitis (FCH) is described and compared with the pathologic features typical of hepatic GVHD. The differential diagnoses of rapidly rising posttransplant liver tests are discussed.


Fibrosing cholestatic hepatitis Chronic viral hepatitis Hepatic GVHD Bile ductular reaction Cholestasis of sepsis Drug induced liver injury Hepatitis C virus 


  1. 1.
    Strasser SI, Sullivan KM, Myerson D, et al. Cirrhosis of the liver in long-term marrow transplant survivors. Blood. 1999;93(10):3259–66.PubMedGoogle Scholar
  2. 2.
    de Latour RP, Ribaud P, Robin M, et al. Allogeneic hematopoietic cell transplant in HCV-infected patients. J Hepatol. 2008;48(6):1008–17.CrossRefGoogle Scholar
  3. 3.
    McDonald GB, Slattery JT, Bouvier ME, et al. Cyclophosphamide metabolism, liver toxicity, and mortality following hematopoietic stem cell transplantation. Blood. 2003;101(5):2043–8.CrossRefGoogle Scholar
  4. 4.
    Strasser SI, Myerson D, Spurgeon CL, et al. Hepatitis C virus infection and bone marrow transplantation: a cohort study with 10-year follow-up. Hepatology. 1999;29(6):1893–9.CrossRefGoogle Scholar
  5. 5.
    Ljungman P, Johansson N, Aschan J, et al. Long-term effects of hepatitis-C virus-infection in allogeneic bone-marrow transplant recipients. Blood. 1995;86(4):1614–8.PubMedGoogle Scholar
  6. 6.
    Lefkowitch JH, Schiff ER, Davis GL, et al. Pathological diagnosis of chronic hepatitis C: a multicenter comparative study with chronic hepatitis B. The Hepatitis Interventional Therapy Group. Gastroenterology. 1993;104(2):595–603.CrossRefGoogle Scholar
  7. 7.
    Oliver NT, Nieto YL, Blechacz B, Anderlini P, Ariza-Heredia E, Torres HA. Severe hepatitis C reactivation as an early complication of hematopoietic cell transplantation. Bone Marrow Transplant. 2017;52(1):138–40.CrossRefGoogle Scholar
  8. 8.
    Torres HA, McDonald GB. How I treat hepatitis C virus infection in patients with hematologic malignancies. Blood. 2016;128(11):1449–57.CrossRefGoogle Scholar
  9. 9.
    Shulman HM, McDonald GB, Matthews D, et al. An analysis of hepatic venocclusive disease and centrilobular hepatic degeneration following bone marrow transplantation. Gastroenterology. 1980;79(6):1178–91.PubMedGoogle Scholar
  10. 10.
    Kleiner D. Liver histology in the diagnosis and prognosis of drug-induced liver injury. Clin Liver Dis. 2014;4(1):12–26.CrossRefGoogle Scholar
  11. 11.
    McDonald GB, Frieze D. A problem-oriented approach to liver disease in oncology patients. Gut. 2008;57(7):987–1003.CrossRefGoogle Scholar
  12. 12.
    Inamoto Y, Storer BE, Petersdorf EW, et al. Incidence, risk factors, and outcomes of sclerosis in patients with chronic graft-versus-host disease. Blood. 2013;121(25):5098–103.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Clinical Research DivisionFred Hutchinson Cancer Research CenterSeattleUSA
  2. 2.Department of PathologyUniversity of Washington School of MedicineSeattleUSA
  3. 3.Pathology SectionSeattle Cancer Care AllianceSeattleUSA

Personalised recommendations