14th Congress of the Middle East Society for Organ Transplantation and the 5th Middle East Transplant Games
Case report
Spontaneous Clearance of Hepatitis C Genotype 4 After Liver Retransplantation

https://doi.org/10.1016/j.transproceed.2014.10.065Get rights and content

Highlights

  • Graft reinfection with HCV is nearly universal after liver transplantation, causing significant morbidity and mortality.

  • Spontaneous clearance of HCV is rare after liver transplantation.

  • Twenty cases of spontaneous clearance of HCV after liver transplantation have been reported in the English literature.

  • 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.

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.

Section snippets

Case Report

A 32-year-old female patient received cadaveric liver transplantation for decompensated HCV-related liver cirrhosis in 2007. The 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 interferon (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

Literature Review

A systematic literature search was performed on Pubmed (January 1, 1990, to December 2013) including search terms hepatitis C infection, spontaneous clearance, liver transplantation, and liver retransplantation. Additional case reports were identified by means of manual review of the identified articles, review articles, and their citations. The number of cases published in English is small (20 patients including our case), reported in 11 papers [8], [9], [10], [11], [12], [13], [14], [15], [16]

Discussion

HCV recurrence after liver transplantation is almost universal; the HCV RNA level is usually high after liver transplantation compared with before transplantation, possibly because of immune suppression [5], [6]. Despite the fact that graft reinfection can be seen as acute infection, the rate of spontaneous clearance after liver transplantation is very rare compared with acute de novo HCV infection in nontransplant settings, where it reaches 10%–50% [4].

The small number of reported cases (n =

Conclusion

Spontaneous clearance of hepatitis C rarely occurs after liver transplantation and extremely rarely after retransplantation. To our knowledge, this is the 1st case of HCV genotype 4 who cleared the virus after cadaveric liver retransplantation. No specific predictor could be identified in the literature, including being an our patient. Possible explanations include pre-transplantation low viral load, alterations in the host immune responses to HCV after transplantation, IL28 B phenotype of the

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