Spontaneous Clearance Of Hcv Accompanying Hepatitis After Liver Transplantation
Kogiso, T., Hashimoto, E., Ikarashi, Y., Kodama, K., Taniai, M., Torii, N., Egawa, H., Yamamoto, M., & Tokushige, K. (2015). spontaneous clearance of HCV accompanying hepatitis after liver transplantation. Clinical journal of gastroenterology, 8(5), 323–329. https://doi.org/10.1007/s12328-015-0602-y
View Original Source →Abstract
Re-infection by the hepatitis C virus (HCV) occurs rapidly after liver transplantation (LT), and spontaneous clearance of HCV is rare under immunosuppressive conditions. Here, we report on two patients who underwent LT to treat liver cirrhosis and hepatocellular carcinoma. The immunosuppressants prescribed were short-term corticosteroids, tacrolimus, and mycophenolate mofetil. A 50-year-old woman underwent LT, with her brother as the donor. She acquired HCV of serological type 1 after LT; the HCV RNA level was 6.0 logIU/mL. Corticosteroids were discontinued within 24 days, with a total dose of 669 mg (adjusted) prednisolone (PSL). The serum alanine aminotransferase (ALT) level increased to 700 U/L by day 55 post-LT. Surprisingly, HCV RNA was not detected on day 87. A 52-year-old man underwent LT, with his sister as the donor. He became rapidly re-infected with HCV of serological type 2; the HCV RNA level was 6.9 logIU/mL. Corticosteroids were given for 24 days, with a total dose of 827 mg (adjusted) PSL. The serum ALT level increased continuously and his HCV cleared 115 days after LT. Both donor and recipient had the major IL28B genotype. HCV was eliminated spontaneously, even under immunosuppressive conditions, after PSL discontinuation without interferon treatment. Minimal use of immunosuppressants and the presence of hepatitis may have contributed to HCV clearance. However, it is important to evaluate additional relevant cases.
Case Details
Disease Location
Liver
Personal Characteristics
A 50-year-old woman was diagnosed with chronic hepatitis c at the age of 33 years, but ifn therapy was contra-indicated, because she exhibited pancytopenia transcatheter arterial chemoembolization (tace) to treat hepatocellular carcinoma (hcc) was performed on several occasions from the time she was 47 years of age. However, further treatment became difficult because of a lack of spare hepatic capacity
Clinical Characteristics
After lt, the donor's liver was reinfected by HCV, and the HCV RNA level was 6.0 logic/ ml. Immunosuppressant therapy was started. On day 36, the serum alanine aminotransferase (alt) level increased to approximately 100 u/l, and a liver biopsy was performed. This revealed lobular hepatitis consistent with HCV recurrence and mild-to-moderate acute cellular rejection. Serological tests for hepatitis b virus (HBV) and cytomegalovirus were both negative. A second liver biopsy specimen taken on day 56 showed moderate endotheliitis in the portal area histologically. The liver biopsy specimen revealed severe lobular hepatitis and mild-to-moderate acute cellular rejection that was more severe than in the earlier biopsy specimen. Many acidophilic bodies (councilman bodies; arrows) and cell dropout were evident, indicative of lobular hepatitis. It could not be determined whether the hepatitis was HCV-related or caused by acute rejection it was thought that ifn therapy for HCV-related hepatitis was a danger for acute rejection exhausted by ifn. Stronger neo-minophagen c (snmc) therapy was given until the acute rejection decreased
Remission Characteristics
No HCV-RNA was evident by day 87 post-lt
Treatment & Mechanisms
Proposed Remission Mechanisms
Immunological response
Clinical Treatment
Left-side liver transplant short-term corticosteroids (methylprednisolone/psl), tacrolimus (fk506), and mycophenolate mofetil (mmf). Liver biopsy stronger neo-minophagen c (snmc)