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.
Highlights
Hepatitis C virus (HCV) infection-associated end-stage liver disease is the leading indication for liver transplantation (LT)
HCV recurrence in the liver graft is common when HCV viremia is confirmed during LT, leading to an accelerated rate of graft failure [1, 2]
Case 1 A 66-year-old man was admitted to our hospital for a living donor liver transplantation (LDLT) for HCVassociated hepatocellular carcinoma (HCC) concomitant with end-stage liver cirrhosis [Child-Pugh score, 9; Tamaki et al Surgical Case Reports (2015) 1:124
Summary
Hepatitis C virus (HCV) infection-associated end-stage liver disease is the leading indication for liver transplantation (LT). Case 2 Our second patient was a 61-year-old man who underwent LDLT for HCV-associated HCC and end-stage liver cirrhosis (Child-Pugh score, 9; MELD score, 11). His IFN therapy failed 21 years before LT due to a psychological side effect. IFN therapy could not obtain a sustained virologic response 8 years before LT His HCV-RNA level was 5.5 log IU/ml preoperatively, and genotype was 1b. On day 14 after steroid pulse therapy, his HCV-RNA decreased below the threshold range and remission was confirmed on day 30 During this period, he developed a high fever of undetectable origin and was diagnosed with the reactivation of CMV infection, which was successfully treated
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