Post-infantile giant cell hepatitis: A single center’s experience over 25 years

Table 1 Reported causes of post-infantile giant cell hepatitis

Infectious	Hepatitis A, B, C
	Epstein-Barr virus (EBV)
	Cytomegalovirus (CMV)
	Paramyxo-like virus
	Human immunodeficiency virus (HIV)
	Herpesvirus 6A
	Human papillomavirus (HPV)
Autoimmune	Autoimmune hepatitis (AIH)
	Ulcerative colitis (UC)
	Primary sclerosing cholangitis (PSC)
	Primary biliary cholangitis (PBC)
	Systemic lupus erythematosus (SLE)
	Rheumatoid arthritis (RA)
	Polyarteritis nodosa (PAN)
Drugs	Methotrexate
	6 mercaptopurine
	Amytriptyline
	P-aminosalicylic acid
	Vinyl chloride
	Chropromazine
	Methotrexate
Hematologic	Chronic lymphocytic leukemia (CLL)
	Lymphoma
	Sickle cell disease (SCC)
	Hypereosinophilia
	Autoimmune hemolytic anemia
Endocrine	Hypoparathyroidism
Infiltrative	Sarcoidosis
Post-transplant	-
Idiopathic	-

Table 2 Patient characteristics and liver function tests

	GCH on native liver, n = 40	GCH on allograft, n = 10
Mean age in yr	50.4	43.4
Gender
Male	14 (35%)	4 (40%)
Female	26 (65%)	6 (60%)
AST	433 ± 486	175 ± 158
ALT	488 ± 537	232 ± 206
Alkaline phosphatase	197 ± 151	296 ± 197
GGT	287 ± 582	246 ± 182
Bilirubin	10.9 ± 10.4	3.1 ± 3.8

GCH: Giant cell hepatitis; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; GGT: γ-Glutamyl transpeptidase.

Table 3 Predisposing factors, n (%)

Predisposing factors	GCH on native liver	GCH on allograft
AIH	13 (32)	3 (30)
Drug induced	6 (15)	0
No factor identified	12 (30)	3 (30)
UC	2 (5)	3 (30)
PSC	3 (7)	1 (10)
HCV	2 (5)	1 (10)
CMV	1 (2)	1 (10)
SLE	2 (5)	0
Lymphoma	2 (5)	0
HAV	1 (2)	0
HBV	1 (2)	0
EBV	1 (2)	0
Sjogren	1 (2)	0
Autoimmune hemolytic anemia	1 (2)	0
CLL	1 (2)	0
Peripheral eosinophilia	1 (2)	0
SCC	1 (2)	0
Celiac disease	1 (2)	0

GCH: Giant cell hepatitis; AIH: Autoimmune hepatitis; UC: Ulcerative colitis; PSC: Primary sclerosing cholangitis; HCV: Hepatitis C virus; CMV: Cytomegalovirus; SLE: Systemic lupus erythematosus; HAV: Hepatitis A virus; HBV: Hepatitis B virus; EBV: Epstein-Barr virus; CLL: Chronic lymphocytic leukemia; SCC: Sickle cell disease.

Table 4 Management and outcomes, n (%)

	GCH on native liver, n = 40	GCH on allograft, n = 10
Management
Immunosuppression	11 (28)	4 (40)
Supportive care	10 (25)	0 (0)
Liver transplantation	5 (13)	1 (10)
Ganciclovir	1 (3)	1 (10)
Unknown	13 (33)	4 (40)
Outcomes
Survived	25 (63)	4 (40)
Died	5 (13)	2 (20)
Unknown	10 (25)	4 (40)

GCH: Giant cell hepatitis.