Recurrent Viral Hepatitis Following Liver Transplantation: Report of 4 Cases

The recurrence of viral hepatitis B or C after liver transplantation is almost universal but their clinical courses and outcomes are vary widely. We investigated four cases of rapidly progressive and fatal recurrent viral hepatitis following liver transplantation, which were rapidly progressive and fatal. Case 1 was a 58-year-old male, who developed recurrent viral hepatitisC. Case 2, 3, and 4 were a 59-year-old female, a 42-year-old male, and a 50-year-old male, respectively, who developed recurrent viral hepatitis B. In cases 1 and 2, the histopathological features of the first liver biopsies were prominent ballooning degeneration of the hepatocytes but later biopsies revealed significant lobular activity. Case 3 began with a marked fatty change and mild lobular and porto-periportal activity and progressed to severe lobular activity and septal fibrosis. In case 4, the first liver biopsy revealed minimal lobular activity but the second biopsy revealed severe lobular activity.

Three cases of pancreas allograft dysfunction

We present dincopathologic features of three cases of biopsy-proven pancreas allograft dysfunction in Korea. All patients had advanced insulin-dependent diabetes mellitus (IDDM). Case 1 was a 30-year-old woman who underwent a simultaneous pancreas-kidney transplantation. Urinary infection developed 6 days after the operation, which remitted and reappeared, when urine amylase level was normal. Since the 55th day after the operation, intermittent hematuria has persisted. Cytomegalovirus inclusions were detected on the urinary bladder and grafted duodenal mucosa. The graft was removed due to perforation of the grafted duodenum and panperitonitis. Case 2 was a 27-year-old man undergoing pancreas transplantation alone (PTA). Ten days after the transplatation, the level of 24 urine amylase decreased and the graft was not delineated by 99mTc DTPA scintigraphy. Allograft needle biopsy revealed multiple acinar cell necrosis and mild lymphocytic infiltration which were compatible with mild acute rejection. Case 3 was a 25-year-old man undergoing cadevaric PTA. Three months after the transplantation, graft was removed due to gastric perforation associated with cytomegalovirus and angiodestructive fungal infection. Various causes of pancreas allograft dysfunction can be diagnosed by needle biopsy, thus appropriate biopsy specimen should be taken using improved biopsy technique.