Spontaneous Clearance Of Hepatitis C Infection After Liver Transplantation From Il28b Rs12979860 Cc Donors
Chin, J. L., Nicholas, R. M., Russell, J., Carr, M., Connell, J., StewART, S., & McCormick, P. A. (2012). spontaneous clearance of hepatitis C infection after liver transplantation from IL28B rs12979860 CC donors. European journal of gastroenterology & hepatology, 24(9), 1110–1112. https://doi.org/10.1097/MEG.0b013e3283554291
View Original Source →Abstract
Genetic polymorphisms adjacent to IL28B have been previously associated with spontaneous clearance of hepatitis C virus (HCV) and a higher rate of sustained virological response to interferon-based treatment in HCV genotype 1-infected patients. A recent study has shown that patients with the CC genotype of the rs12979860 single nucleotide polymorphism upstream from the IL28B gene are more likely to clear HCV spontaneously relative to the CT or TT genotype. In the liver transplant cohort, HCV recurs almost universally in patients with detectable HCV RNA at the time of transplantation. The spontaneous clearance of HCV infection after transplant is very rare. We report two cases of spontaneous clearance of HCV genotype 1 infection after liver transplantation from homozygous IL28B CC donors. This finding may be explained by alterations in the host immune responses to HCV after transplantation with a CC donor liver, which has potential implications for donor selection in HCV-positive recipients.
Case Details
Disease Location
Liver
Personal Characteristics
40 -year-old caucasian man treatment-naıve HCV genotype 1a infection and a history of alcohol abuse
Clinical Characteristics
Received a cadaveric liver transplant for end-stage liver disease. HCV RNA level before transplantation was 24 iu/ml. After liver transplantation, he was commenced on corticosteroid and daclizumab started on a 0.1 mg/kg tacrolimus, when his renal function improved at day 6. Nine days later, he underwent a percutaneous liver biopsy for elevated cholestatic liver enzymes, which indicated severe acute cellular rejection. Another liver biopsy was performed 5 months after liver transplantation. Histology showed mild lobular hepatitis consistent with HCV recurrence
Remission Characteristics
HCV RNA was not detected at 34, 35, 37 and 42 months after liver transplantation
Treatment & Mechanisms
Proposed Remission Mechanisms
The donor il28b genotype is the most important factor determining spontaneous clearance in these two patients.
Clinical Treatment
Cadaveric liver transplant for end-stage liver disease corticosteroid treatment (methylprednisolone 16 mg/day, followed by prednisolone 20 mg/day, tapered dose) and daclizumab. Liver biopsy. Methylprednisolone and mycophenolate mofetil 3 g/day after liver biopsy