Spontaneous clearance of HCV accompanying hepatitis after liver transplantation

Kogiso, Tomomi; Hashimoto, Etsuko; Ikarashi, Yuichi; Kodama, Kazuhisa; Taniai, Makiko; Torii, Nobuyuki; Egawa, Hiroto; Yamamoto, Masakazu; Tokushige, Katsutoshi

doi:10.1007/s12328-015-0602-y

Cited by 8 publications

(7 citation statements)

References 35 publications

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“…HCV reinfection results in graft dysfunction with progression to cirrhosis in about one-third of patients within 5 years after LT compared to less than 5% in non-transplant patients[ 15 ]. Spontaneous viral clearance following LT is reported in a few published cases although the underlying mechanism is not clearly understood[ 16 ]. Nevertheless, HCV infection of allograft has protracted course with rapid progression and higher mortality risk compared to non-transplant chronic HCV infection.…”

Section: Natural History Of Hcv In Liver Transplant Recipientsmentioning

confidence: 99%

Use of direct-acting antiviral agents in hepatitis C virus-infected liver transplant candidates

Gadiparthi

Cholankeril

Perumpail

et al. 2018

WJG

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Since the advent of direct acting antiviral (DAA) agents, chronic hepatitis C virus (HCV) treatment has evolved at a rapid pace. In contrast to prior regimen involving ribavirin and pegylated interferon, these newer agents are highly effective, well-tolerated, have shorter course of therapy and safer essentially in all HCV patients including those with advanced liver disease and following liver transplantation. Clinicians caring for HCV-infected patients on the liver transplant (LT) waitlist are often faced with a dilemma whether to treat HCV infection before or after liver transplantation. Sustained virological response (SVR) rates following HCV treatment may improve hepatic function sufficiently enough to negate the need for LT in certain patients. On the other hand, the decrease in MELD without improvement in quality of life in certain patients may lead to delay or dropout from potentially curative LT surgery list. In this context, our review focuses on the approach to and optimal timing of DAA-based treatment of HCV infection in LT candidates in the peri-transplant period.

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Section: Natural History Of Hcv In Liver Transplant Recipientsmentioning

confidence: 99%

Use of direct-acting antiviral agents in hepatitis C virus-infected liver transplant candidates

Gadiparthi

Cholankeril

Perumpail

et al. 2018

WJG

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“…However, in chronically infected HCV-seropositive patients at the time of LT, recurrence of HCV infection in the graft is universal, with up to one-third of patients progressing from graft dysfunction to cirrhosis within 5 years of LT. 15 Few published cases describe spontaneous clearance of HCV infection following LT without a clearly defined mechanism. 16 Nonetheless, such cases are rare. In a study evaluating 149 patients with recurrent post-transplant HCV infection, 12% experienced no evidence of chronic hepatitis on liver biopsy while 70% developed mild chronic hepatitis within 6 months.…”

Section: Hcv Infection In Liver Transplant Recipientsmentioning

confidence: 99%

Timing of Hepatitis C Virus Treatment in Liver Transplant Candidates in the Era of Direct-acting Antiviral Agents

Cholankeril

Joseph-Talreja

Perumpail

et al. 2017

Journal of Clinical and Translational Hepatology

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Chronic hepatitis C virus (HCV) infection remains the leading indication for liver transplantation (LT) in the United States. While most patients with chronic HCV infection remain asymptomatic, up to one-third develop progressive liver disease resulting in cirrhosis. LT is often the only curative treatment once significant hepatic decompensation develops. However, antiviral therapy for HCV infection has advanced markedly in the past 5 years with the discovery and approval of direct-acting antiviral agents. These new regimens are well tolerated, of short duration and highly effective, unlike the traditional treatment with pegylated-interferon and ribavirin. As achieving sustained virological response becomes increasingly attainable for a majority of HCV-infected patients, concerns have been raised regarding the optimal timing of treatment for HCV infection in the setting of end-stage liver disease and during the peri-transplant period. On one hand, HCV treatment may improve hepatic function and negate the need for LT in some, which is crucial given the scarcity of donor organs and mortality on the waiting list in certain regions. On the other hand, HCV treatment may result in lowering the priority for LT without improving quality of life, thereby delaying potentially curative LT surgery. This review evaluates the evidence supporting the use of direct-acting antiviral agents in the period before and following LT.

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“…By contrast, spontaneous clearance of serum HCV in patients with chronic infection is rare, with an incidence rate of 0.11 to 0.74 per 100 person-years [ 2 , 3 ]. Spontaneous clearance of HCV-RNA has also been reported after total gastrectomy [ 4 ], use of minimal immunosuppressants and prednisolone in patients with HCV reinfection after liver transplantation [ 5 ], use of immune checkpoint inhibitors in the oncology setting [ 6 ], and initiation of highly active antiretroviral therapy for human immunodeficiency virus (HIV) coinfection [ 7 ]. A T-lymphocyte response is thought to be involved in HCV-RNA clearance [ 3 , 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Spontaneous clearance of serum HCV-RNA after splenectomy in a patient with HCV-related liver cirrhosis and portal hypertension: a case report

Ogata,

Sakai,

Shibata

et al. 2024

surg case rep

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Background Spontaneous clearance of chronic hepatitis C virus (HCV) is rare in adults. A T-lymphocyte response is thought to be involved in HCV-RNA clearance. Splenectomy reportedly has a beneficial effect on T cell immune function in patients with cirrhosis. To the best of our knowledge, the present report is the first to describe spontaneous clearance of serum HCV-RNA within 1 year after splenectomy in a patient with cirrhosis. Case presentation A 55-year-old man with HCV cirrhosis was transferred to our institution with advanced pancytopenia, splenomegaly, and gastric varices. He had a 1-year history of ascites, edema, and general fatigue. The patient had a Child–Pugh score of 8 and serological type 1 HCV; the HCV-RNA level was 4.7 log IU/mL. Contrast-enhanced computed tomography showed gastric varices and marked splenomegaly (estimated spleen volume of 2175 mL). Esophagogastroduodenoscopy revealed enlarged gastric varices with no red color sign, and the varices were larger than those 1 year prior. He was diagnosed with decompensated HCV-related liver cirrhosis and portal hypertension. We considered direct-acting antiviral (DAA) therapy; however, DAA therapy was not approved in Japan for patients with decompensated cirrhosis at that time. Hand-assisted laparoscopic splenectomy was performed to improve the worsening portal hypertension. Further, we planned the initiation of DAA therapy after surgery, when such therapy would become available. DAA therapy was approved 1 year after splenectomy. At that time, we measured the HCV-RNA level before the initiation of DAA therapy; unexpectedly, however, serum HCV-RNA was not detectable, and the virus continued to disappear during the following 4 years. His liver function (total bilirubin, albumin, and prothrombin time) and pancytopenia improved during the 5 years postoperatively. The serum aspartate and alanine aminotransferase levels normalized between 1 and 5 years postoperatively. Esophagogastroduodenoscopy showed no change in the gastric varices during the 5 years after surgery. The patient remained asymptomatic and continued to do well. Conclusions We have presented a case of spontaneous clearance of HCV-RNA after splenectomy in a patient with cirrhosis and portal hypertension. Splenectomy may be associated with disappearance of HCV-RNA based on previous reports. More cases should be accumulated and evaluated.

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Spontaneous clearance of HCV accompanying hepatitis after liver transplantation

Cited by 8 publications

References 35 publications

Use of direct-acting antiviral agents in hepatitis C virus-infected liver transplant candidates

Use of direct-acting antiviral agents in hepatitis C virus-infected liver transplant candidates

Timing of Hepatitis C Virus Treatment in Liver Transplant Candidates in the Era of Direct-acting Antiviral Agents

Spontaneous clearance of serum HCV-RNA after splenectomy in a patient with HCV-related liver cirrhosis and portal hypertension: a case report

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