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Spontaneous clearance of hepatitis C genotype 4 after liver retransplantation
H Elsiesy1, F Abaalkhail1, M Al Sebayel1
1Department of Liver and Small Bowel Transplantation and Hepatic-Biliary-Pancreatic Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Insights
Spontaneous clearance of Hepatitis C virus (HCV) after liver retransplantation is exceptionally rare. This case report details the first documented instance of spontaneous HCV genotype 4 clearance post-second liver transplant.
Area of Science:
- Hepatology
- Virology
- Immunology
Background:
- Hepatitis C virus (HCV)-related cirrhosis is a leading cause for liver transplantation globally.
- Graft reinfection post-transplant is common, leading to significant patient morbidity and mortality.
- Spontaneous clearance of HCV after liver transplantation, especially retransplantation, is exceedingly rare.
Observation:
- A 32-year-old female with HCV cirrhosis underwent a second liver transplant in March 2013.
- She experienced HCV recurrence (genotype 4) post-transplant, with high viral load and intolerance to interferon therapy.
- HCV RNA levels spontaneously became undetectable shortly after the second transplant, confirmed in May 2013.
Findings:
- This case represents the first documented spontaneous clearance of Hepatitis C virus genotype 4 following liver retransplantation.
- The spontaneous viral clearance occurred despite previous recurrence and intolerance to antiviral treatment.
- The event suggests potential alterations in host immune responses post-retransplantation may contribute to viral clearance.
Implications:
- This rare event offers insights into the complex host-immune-viral dynamics after liver retransplantation.
- Further research into immune system modulation post-transplant may reveal novel strategies for managing HCV recurrence.
- Understanding spontaneous clearance mechanisms could inform future therapeutic approaches for post-transplant Hepatitis C.
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.
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