14th Congress of the Middle East Society for Organ Transplantation and the 5th Middle East Transplant GamesCase reportSpontaneous Clearance of Hepatitis C 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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Cited by (1)
Learning from a rare phenomenon — spontaneous clearance of chronic hepatitis C virus post-liver transplant: A case report
2022, World Journal of Hepatology