Spontaneous Clearance Of Hepatitis C Genotype 4 After Liver Retransplantation
Elsiesy, H., Abaalkhail, F., Al Sebayel, M., Broering, D., Al Hamoudi, W., Yousif, S., Al-Kattan, W., & Selim, K. (2015). spontaneous clearance of hepatitis C genotype 4 after liver retransplantation. Transplantation proceedings, 47(4), 1234–1237. https://doi.org/10.1016/j.transproceed.2014.10.065
View Original Source →Abstract
BACKGROUND: Hepatitis C virus (HCV)-related cirrhosis remains the most common indication for liver transplantation worldwide. Graft reinfection with HCV is nearly universal, causing significant morbidity and mortality. Spontaneous clearance of HCV after liver transplantation and retransplantation is extremely rare. We report a case of spontaneous clearance of HCV genotype 4 that occurred shortly after 2nd liver transplantation. CASE REPORT: A 32-year-old female patient received a cadaveric liver transplant for HCV-related cirrhosis in 2007. She was not treated for HCV before transplantation. The patient developed biopsy-proven HCV recurrence with elevated transaminases and 65,553 IU/mL HCV RNA, genotype 4. She could not tolerate interferon-based treatment. The patient's condition progressively worsened and required a 2nd cadaveric liver transplantation in March 2013. Immunosuppression initially included steroids and Prograf, which was then switched to cyclosporine after the patient developed seizure. She developed acute cellular rejection which was readily treated with immunosuppression adjustment. HCV RNA became negative in April, which was confirmed in May 2013. CONCLUSIONS: Spontaneous clearance of hepatitis C rarely occurs after liver transplantation and is extremely rare after retransplantation. This finding may be explained by alterations in the host immune responses to HCV after transplantation. To our knowledge, this is the first case of spontaneous clearance of HCV genotype 4 after liver retransplantation.
Case Details
Disease Location
Liver
Personal Characteristics
32-year-old female patient received a cadaveric liver transplant for HCV-related cirrhosis in 2007
Clinical Characteristics
Patient developed histologically confirmed HCV recurrence; liver biopsy in october 2011 showed recurrent hepatitis c, grade 2 and stage f4 (metavir score) she could not tolerate (ifn) based treatment in september 2012, she developed ascites and massive right hepatic hydrothorax; HCV RNA was 65,553 iu/ ml, genotype 4. Serology for HIV and hepatitis b were negative, as were autoimmune markers; antinuclear antibody (ab), smooth muscle ab, and liver-kidney microsomal ab. There was no evidence of metabolic liver diseases on march 26, liver enzymes were raised: alanine transaminase, 144 u/l; aspartate transaminase, 136u/l; gamma glutamyl transpepatientidase, 680 iu/l; alkaline phosphatase, 496 u/l; and bilirubin, 54 mmol/l; with normal liver sonogram. No liver biopsy was done
Remission Characteristics
Liver enzymes normalized 3 days after adjusting cyclosporine level. HCV RNA came back undetectable on april 13, which was confirmed several times later: on may 17, september 6, and december 20, 2013 this is likely the 1st case of HCV genotype 4 spontaneous clearance after liver retransplantation
Treatment & Mechanisms
Proposed Remission Mechanisms
Possible explanations include pre-transplantation low viral load, alterations in the host immune responses to HCV after transplantation, il28 b phenotype of the donor, development of HCV-specific t-cell response, and production of th1 cytokines in the liver
Clinical Treatment
Patient was resisted and received a 2nd cadaveric liver transplant on march 13, 2013. She received standard immunosuppression with the use of prograf and tapering steroids, but was switched to cyclosporine after she developed seizure at postoperative day 5