Skip to main content

Advertisement

SpringerLink
Log in

Spontaneous clearance of HCV accompanying hepatitis after liver transplantation

  • Case Report
  • Published:
Clinical Journal of Gastroenterology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Gane E. The natural history and outcome of liver transplantation in hepatitis C virus-infected recipients. Liver Transpl. 2003;9:S28–34.

    Article  PubMed  Google Scholar 

  2. Berenguer M, Prieto M, Rayón JM, et al. Natural history of clinically compensated hepatitis C virus-related graft cirrhosis after liver transplantation. Hepatology. 2000;32:852–8.

    Article  CAS  PubMed  Google Scholar 

  3. Gallegos-Orozco JF, Yosephy A, Noble B, et al. Natural history of post-liver transplantation hepatitis C: a review of factors that may influence its course. Liver Transpl. 2009;15:1872–81.

    Article  PubMed  Google Scholar 

  4. Gane EJ, Portmann BC, Naoumov NV, et al. Long-term outcome of hepatitis C infection after liver transplantation. N Engl J Med. 1996;334:815–20.

    Article  CAS  PubMed  Google Scholar 

  5. Wali M, Harrison RF, Gow PJ, et al. Advancing donor liver age and rapid fibrosis progression following transplantation for hepatitis C. Gut. 2002;51:248–52.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  6. Micallef JM, Kaldor JM, Dore GJ. Spontaneous viral clearance following acute hepatitis C infection: a systematic review of longitudinal studies. J Viral Hepat. 2006;13:34–41.

    Article  CAS  PubMed  Google Scholar 

  7. Doughty AL, Zekry A, Spencer JD, et al. Spontaneous clearance of hepatitis C virus infection post-liver transplantation is associated with rapidly changing quasispecies: a single case report. Liver Transpl. 2000;6:648–53.

    Article  CAS  PubMed  Google Scholar 

  8. Casanovas-Taltavull T, Ercilla MG, Gonzalez CP, et al. Long-term immune response after liver transplantation in patients with spontaneous or post-treatment HCV-RNA clearance. Liver Transpl. 2004;10:584–94.

    Article  PubMed  Google Scholar 

  9. Neumann UP, Berg T, Bahra M, et al. Long-term outcome of liver transplants for chronic hepatitis C: a 10-year follow-up. Transplantation. 2004;77:226–31.

    Article  PubMed  Google Scholar 

  10. Samonakis DN, Cholongitas E, Triantos CK, et al. Sustained, spontaneous disappearance of serum HCV-RNA under immunosuppression after liver transplantation for HCV cirrhosis. J Hepatol. 2005;43:1091–3.

    Article  CAS  PubMed  Google Scholar 

  11. Suneetha PV, Mederacke I, Heim A, et al. Spontaneous clearance of chronic hepatitis C after liver transplantation: are hepatitis C virus-specific T cell responses the clue? Liver Transpl. 2008;14:1225–7.

    Article  CAS  PubMed  Google Scholar 

  12. Weber NK, Trotter JF. Spontaneous clearance of hepatitis C virus after liver transplantation. Transplantation. 2009;87:1102–3.

    Article  PubMed  Google Scholar 

  13. Dale CH, Burns P, McCutcheon M, et al. Spontaneous clearance of hepatitis C after liver and renal transplantation. Can J Gastroenterol. 2009;23:265–7.

    PubMed Central  CAS  PubMed  Google Scholar 

  14. Haque M, Hashim A, Greanya ED, et al. Spontaneous clearance of hepatitis C infection post-liver transplant: a rare but real phenomenon? A case report and review of the literature. Ann Hepatol. 2010;9:202–6.

    PubMed  Google Scholar 

  15. Chin JL, Nicholas RM, Russell J, et al. Spontaneous clearance of hepatitis C infection after liver transplantation from IL28B rs12979860 CC donors. Eur J Gastroenterol Hepatol. 2012;24:1110–2.

    Article  PubMed  Google Scholar 

  16. Raghuraman S, Park H, Osburn WO, et al. Spontaneous clearance of chronic hepatitis C virus infection is associated with appearance of neutralizing antibodies and reversal of T-cell exhaustion. J Infect Dis. 2012;205:763–71.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  17. Ciesek S, Steinmann E, Iken M, et al. Glucocorticosteroids increase cell entry by hepatitis C virus. Gastroenterology. 2010;138:1875–84.

    Article  CAS  PubMed  Google Scholar 

  18. Somsouk M, Lauer GM, Casson D, et al. Spontaneous resolution of chronic hepatitis C virus disease after withdrawal of immunosuppression. Gastroenterology. 2003;124:1946–9.

    Article  PubMed  Google Scholar 

  19. Neumann UP, Neuhaus P. Discussion on spontaneous resolution of chronic hepatitis C virus after withdrawal of immunosuppression. Gastroenterology. 2004;126: 627 (author reply 628).

  20. Nakagawa M, Sakamoto N, Tanabe Y, et al. Suppression of hepatitis C virus replication by cyclosporin a is mediated by blockade of cyclophilins. Gastroenterology. 2005;129:1031–41.

    Article  CAS  PubMed  Google Scholar 

  21. Samonakis DN, Germani G, Burroughs AK. Immunosuppression and HCV recurrence after liver transplantation. J Hepatol. 2012;56:973–83.

    Article  CAS  PubMed  Google Scholar 

  22. Ge D, Fellay J, Thompson AJ, et al. Genetic variation in IL28B predicts hepatitis C treatment-induced viral clearance. Nature. 2009;461:399–401.

    Article  CAS  PubMed  Google Scholar 

  23. Tanaka Y, Nishida N, Sugiyama M, et al. Genome-wide association of IL28B with response to pegylated interferon-alpha and ribavirin therapy for chronic hepatitis C. Nat Genet. 2009;41:1105–9.

    Article  CAS  PubMed  Google Scholar 

  24. Thomas DL, Thio CL, Martin MP, et al. Genetic variation in IL28B and spontaneous clearance of hepatitis C virus. Nature. 2009;461:798–801.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  25. Grebely J, Page K, Sacks-Davis R, et al. The effects of female sex, viral genotype, and IL28B genotype on spontaneous clearance of acute hepatitis C virus infection. Hepatology. 2014;59:109–20.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  26. Westbrook RH, Dusheiko G. Natural history of hepatitis C. J Hepatol. 2014;61:S58–68.

    Article  PubMed  Google Scholar 

  27. Hoffmann FS, Schmidt A, Dittmann Chevillotte M, et al. Polymorphisms in melanoma differentiation-associated gene 5 link protein function to clearance of hepatitis C virus. Hepatology. 2015;61:460–70.

    Article  CAS  PubMed  Google Scholar 

  28. Bhagat V, Foont JA, Schiff ER, et al. Spontaneous clearance of hepatitis C virus after liver transplantation in two patients coinfected with hepatitis C virus and human immunodeficiency virus. Liver Transpl. 2008;14:92–5.

    Article  PubMed  Google Scholar 

  29. Hanson RG, Peters MG, Hoofnagle JH. Effects of immunosuppressive therapy with prednisolone on B and T lymphocyte function in patients with chronic type B hepatitis. Hepatology. 1986;6(2):173–9.

    Article  CAS  PubMed  Google Scholar 

  30. Rauch A, Kutalik Z, Descombes P, et al. Genetic variation in IL28B is associated with chronic hepatitis C and treatment failure: a genome-wide association study. Gastroenterology. 2010;138:1338–45, 45.e1–7.

  31. El Awady MK, Bader El Din NG, Abdel Aziz Riad M, et al. Predictors of disease recurrence post living donor liver transplantation in end stage chronic HCV patients. Dis Markers. 2014;2014:202548.

    Article  PubMed Central  PubMed  Google Scholar 

  32. Lange CM, Moradpour D, Doehring A, et al. Impact of donor and recipient IL28B rs12979860 genotypes on hepatitis C virus liver graft reinfection. J Hepatol. 2011;55:322–7.

    Article  CAS  PubMed  Google Scholar 

  33. Fukuhara T, Taketomi A, Motomura T, et al. Variants in IL28B in liver recipients and donors correlate with response to peg-interferon and ribavirin therapy for recurrent hepatitis C. Gastroenterology. 2010;139:1577–85, 85.e1–3.

  34. Grebely J, Dore GJ, Kim AY, et al. Genetics of spontaneous clearance of hepatitis C virus infection: a complex topic with much to learn. Hepatology. 2014;60:2127–8.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by the Takako Satake Award administered by Tokyo Women’s Medical University and a Grant-in-Aid from the Ministry of Education, Culture, Sports, Science, and Technology of Japan (#26461024-0001) to T.K.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Institute of Gastroenterology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Tomomi Kogiso, Etsuko Hashimoto, Yuichi Ikarashi, Kazuhisa Kodama, Makiko Taniai, Nobuyuki Torii & Katsutoshi Tokushige

  2. Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Hiroto Egawa & Masakazu Yamamoto

Authors
  1. Tomomi Kogiso
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Etsuko Hashimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yuichi Ikarashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kazuhisa Kodama
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Makiko Taniai
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nobuyuki Torii
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hiroto Egawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Masakazu Yamamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Katsutoshi Tokushige
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tomomi Kogiso.

Ethics declarations

Conflict of Interest:

Tomomi Kogiso, Etsuko Hashimoto, Yuichi Ikarashi, Kazuhisa Kodama, Makiko Taniai, Nobuyuki Torii, Hiroto Egawa, Masakazu Yamamoto, and Katsutoshi Tokushige declare that they have no conflict of interest.

Human/Animal Rights:

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008(5).

Informed Consent:

Informed consent was obtained from all patients for being included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kogiso, T., Hashimoto, E., Ikarashi, Y. et al. Spontaneous clearance of HCV accompanying hepatitis after liver transplantation. Clin J Gastroenterol 8, 323–329 (2015). https://doi.org/10.1007/s12328-015-0602-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12328-015-0602-y

Keywords

Search

Navigation