University of British Columbia, Canada.
Ann Hepatol. 2010 Apr-Jun;9(2):202-6.
Recurrent hepatitis C virus (HCV) infection after liver transplantation is a significant cause of morbidity, mortality and graft loss. Spontaneous clearance of recurrent HCV after liver transplant is a rarely reported phenomenon. We report a case of a 66-year-old woman who underwent liver transplantation for HCV cirrhosis (treatment- naive genotype 2) under immunosuppression with tacrolimus, mycophenolate mofetil (MMF), and short-term corticosteroids. The patient developed histologically proved severe cholestatic recurrence of HCV hepatitis. Immunosuppression was reduced to tacrolimus monotherapy because of cytopenia. She subsequently became RNA negative at week 44 post- transplant while on tacrolimus and MMF despite no antiviral therapy. A spontaneous sustained virologic clearance was confirmed with subsequent HCV nucleotide testing. Only a few similar cases have been reported in the literature with uninterrupted immunosuppression and subsequent spontaneous clearance. Our experience, and the few other published cases in the literature, suggests that spontaneous clearance of HCV after liver transplantation is a rare but real phenomenon. Better understanding of this phenomenon may help to manage recurrent HCV disease after transplantation.
肝移植后丙型肝炎病毒 (HCV) 复发是发病率、死亡率和移植物丢失的重要原因。肝移植后 HCV 自发清除是一种罕见的现象。我们报告了一例 66 岁女性，因 HCV 肝硬化（无治疗史，基因型 2）接受肝移植，免疫抑制方案为他克莫司、霉酚酸酯（MMF）和短期皮质类固醇。该患者发生组织学证实的严重胆汁淤积性 HCV 肝炎复发。由于血细胞减少，免疫抑制减至他克莫司单药治疗。尽管未进行抗病毒治疗，但她在移植后第 44 周时，在接受他克莫司和 MMF 治疗时 RNA 转为阴性。随后 HCV 核苷酸检测证实了自发持续病毒学清除。文献中仅有少数类似病例报道，这些病例在持续免疫抑制和随后的自发清除过程中未中断。我们的经验和文献中的少数其他已发表病例表明，肝移植后 HCV 的自发清除是一种罕见但真实的现象。更好地了解这一现象可能有助于管理肝移植后复发性 HCV 疾病。
