Spontaneous clearance of hepatitis C virus after liver transplantation: a report of four cases

Abstract

End-stage liver disease associated with hepatitis C virus (HCV) infection is the leading indication for liver transplantation. Hepatitis C virus infection recurrence in the graft is common under immunosuppression, leading to an accelerated rate of graft failure. We report the clinical features of four of our patients: three patients presenting with spontaneous hepatitis C virus clearance after liver transplantation and one presenting with transient disappearance of hepatitis C virus postoperatively. The transitional period from surgery to hepatitis C virus clearance was <5 months for all patients. The immunosuppression therapy included tacrolimus, mycophenolate mofetil, and corticosteroids. One ABO-incompatible patient presented spontaneous viral clearance postoperatively for the last 5 years. Two patients had episodes of severe bacterial infection, which resulted in a temporary reduction of immunosuppression. Two patients presented with a transient elevation of transaminase preceding spontaneous hepatitis C virus clearance. These clinical findings suggested that factors including surgical stress, severe bacterial infection, and temporary interruption of immunosuppression were correlated with the reactivation of nonspecific immune responses in the hosts, resulting in spontaneous hepatitis C virus clearance postoperatively.

Transplantation of kidneys from hepatitis C–infected donors to hepatitis C–negative recipients: Single center experience

“…A comprehensive metabolic panel was collected weekly after renal transplantation for up to 3 to 6 months. As there have been reports of spontaneous clearance of HCV infection even in transplant recipients 15,16 and the current AASLD/IDSA guidelines recommend waiting for 12 to 16 weeks to allow spontaneous clearance of HCV in the setting of an acute infection, our patients were tested for HCV RNA and HCV genotype between 4 to 8 weeks after transplant. Patients with detectable HCV RNA were started on a DAA regimen (glecaprevir/pibrentasvir, sofosbuvir/velpatasvir, or sofosbuvir/ledipasvir) for at least 12 weeks by our hepatologists.…”

Learning from a rare phenomenon — spontaneous clearance of chronic hepatitis C virus post-liver transplant: A case report

“…We also performed a literature review to identify additional cases of spontaneous HCV resolution post-LT to better understand factors associated with this phenomenon. We used a similar strategy as Tamaki et al [ 11 ], but did not exclude patients on HAART, interferon or ribavirin. We completed a systematic review using PubMed from August 2015 to January 2020 by including keywords of LT and spontaneous clearance of HCV.…”

Spontaneous Clearance of Hepatitis C Virus after Liver Transplantation, A Report of Two Cases

“…There are several reports of spontaneous HCV clearance after liver transplantation [8,[11][12][13][23][24][25][26][27][28]. Different reports had identified different speculative factors for viral clearance; withdrawal of immunosuppression [8,24], renal impairment, proteinuria, pretransplant exposure to interferon, and change of immunosuppression, antiretroviral therapy given for HIV coinfection or HBV coinfection [23], liver transplantation from homozygous IL28B CC donors [11].…”