Background: Plasma cell hepatitis (PCH) is an uncommon liver graft dysfunction which occurs in liver transplant (LT) recipients of different etiologies other than autoimmune hepatitis. It is characterized by severe degree of necroinflammation with plasma cells comprising >30% of the infiltrate, and typically progresses to end-stage liver disease requiring re-LT. We evaluated the prevalence and characteristics of primary sclerosing cholangitis (PSC) patients who developed PCH.

Methods: Pathology database search was performed to identify PSC patients who underwent LT and developed PCH at our institution in the last 15 years (2002-2016). One older PCH case (1996) and two additional PCH cases from our consultation service were also reviewed. Retrospective evaluation of the clinical and pathologic information of PSC patients who developed PCH was performed.

Results: Eighty-eight PSC patients underwent LT at our institution over a 15-year-period. Nine patients who underwent a repeat LT were excluded from the study. Five patients (6.5%) eventually developed PCH. A total of 71 patient-years from 8 PSC patients were evaluated (see Table 1). Four of these patients (50%) had ulcerative colitis and one of them (12.5%) had Crohn's disease. Most episodes of PCH coincided with elevated ALT (88.2%, mean = 176.1 U/L), AST (88.8%, mean = 170 U/L), alkaline phosphatase (72.2%, mean = 236 U/L), and GGT levels (86.7%, mean = 142.7 U/L).

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Conclusions: In the post-LT setting, PCH is an important diagnostic consideration in PSC patients who present with elevated liver enzymes. PCH may present either early or late in these patients. Acute cellular rejection (ACR) may precede PCH. Moreover, PSC recurrence is common and only a small number of patients require re-LT.

CITATION INFORMATION: Putra J, Schiano T, Fiel M. Plasma Cell Hepatitis in Primary Sclerosing Cholangitis Patients: 15-Year Experience at a Transplant Center. Am J Transplant. 2017;17 (suppl 3).

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