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Spontaneous Clearance Of Hepatitis C Infection After Liver Transplantation From Il28b Rs12979860 Cc Donors

Chin et al., 2012Other/Unknown

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

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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

41 -year-old caucasian male treatment-naıve HCV genotype 1a infection and a history of alcohol abuse

Clinical Characteristics

Received a cadaveric liver transplant for end-stage liver disease. He was commenced on corticosteroid treatment. 8 months later qualitative HCV pcr was positive. Percutaneous liver biopsy was performed. It showed only mild nonspecific portal hepatitis. Nine years after transplantation, he presented to his local hospital with jaundice and ascites.

Remission Characteristics

Nine years HCV RNA and cytomegalovirus were not detected.

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. Methylprednisolone 16 mg/day followed by prednisolone 20 mg/day, tapered dose, tacrolimus 0.1 mg/kg/day and azathioprine 1 mg/kg/day. Liver biopsy