Plasma cell hepatitis induced by the termination of antiviral therapy for recurrent hepatitis C after living donor liver transplantation

Abstract

Plasma cell hepatitis (PCH) is an idiopathic disorder characterized by plasma cell infiltration in the allografts of patients who have undergone liver transplantation. Although an increasing number of cases of PCH have been reported in liver transplant recipients with hepatitis C recurrence treated with interferon, it is unclear whether PCH is induced by interferon itself. Here, we describe the cases of two patients who developed PCH just after the termination of antiviral therapy for recurrent hepatitis C after living donor liver transplantation. Liver dysfunction appeared at 1 month in one patient and 2 months in the other patient after pegylated interferon plus ribavirin therapy, and liver histology showed interface hepatitis with plasma cell-rich lymphoid aggregates. Both patients recovered after steroid therapy and achieved sustained virological response. These cases suggest that PCH could be induced by the alteration of the immune condition resulting from the termination of antiviral therapy. PCH should be considered when the transaminase levels increase after antiviral therapy, and it should be carefully distinguished from hepatitis C relapse.

Three patients treated with daclatasvir and asunaprevir for recurrent hepatitis C after liver transplantation: Case report

“…However, IFN‐mediated graft dysfunction is a significant clinical problem that warrants particular caution following living donor LT . Moreover, it was reported that IFN‐based antiviral therapy for recurrent hepatitis C after living donor LT had the potential for causing plasma cell hepatitis and chronic rejection . Therefore, for such difficult‐to‐treat post‐LT patients, IFN‐free daclatasvir and asunaprevir combination therapy will likely be a standard therapy …”

Sustained virological response to antiviral therapy improves survival rate in patients with recurrent hepatitis C virus infection after liver transplantation

“…In five patients, rejection progressed rapidly and resulted in death within 3 months after diagnosis . On the other hand, plasma cell hepatitis induced by antiviral therapy for recurrent hepatitis C after LDLT . Although it is important that SVR induced by IFN therapy improved survival rate in patients with recurrent post‐LDLT HCV infection, IFN therapy may be recommended in these patients while we are careful of chronic rejection and plasma cell hepatitis.…”

Liver transplantation and autoimmune hepatitis

“…Importantly, there have been several publications regarding de novo hepatitis during or after interferon-based anti-HCV treatment for recurrent hepatitis C posttransplantation (67)(68)(69). However, its pathophysiology is still uncertain, and it is still controversial whether de novo AIH represents a specific type of rejection or a form of have reported recurrent AIH posttransplantation (8,32), since the first report by Neuberger et al in 1984 (33).…”