Kogiso Tomomi, Hashimoto Etsuko, Ikarashi Yuichi, Kodama Kazuhisa, Taniai Makiko, Torii Nobuyuki, Egawa Hiroto, Yamamoto Masakazu, Tokushige Katsutoshi
Department of Internal Medicine, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
Clin J Gastroenterol. 2015 Oct;8(5):323-9. doi: 10.1007/s12328-015-0602-y. Epub 2015 Sep 5.
Re-infection by the hepatitis C virus (HCV) occurs rapidly after liver transplantation (LT), and spontaneous clearance of HCV is rare under immunosuppressive conditions. Here, we report on two patients who underwent LT to treat liver cirrhosis and hepatocellular carcinoma. The immunosuppressants prescribed were short-term corticosteroids, tacrolimus, and mycophenolate mofetil. A 50-year-old woman underwent LT, with her brother as the donor. She acquired HCV of serological type 1 after LT; the HCV RNA level was 6.0 logIU/mL. Corticosteroids were discontinued within 24 days, with a total dose of 669 mg (adjusted) prednisolone (PSL). The serum alanine aminotransferase (ALT) level increased to 700 U/L by day 55 post-LT. Surprisingly, HCV RNA was not detected on day 87. A 52-year-old man underwent LT, with his sister as the donor. He became rapidly re-infected with HCV of serological type 2; the HCV RNA level was 6.9 logIU/mL. Corticosteroids were given for 24 days, with a total dose of 827 mg (adjusted) PSL. The serum ALT level increased continuously and his HCV cleared 115 days after LT. Both donor and recipient had the major IL28B genotype. HCV was eliminated spontaneously, even under immunosuppressive conditions, after PSL discontinuation without interferon treatment. Minimal use of immunosuppressants and the presence of hepatitis may have contributed to HCV clearance. However, it is important to evaluate additional relevant cases.
丙型肝炎病毒（HCV）在肝移植（LT）后迅速再次感染，在免疫抑制条件下HCV自发清除极为罕见。在此，我们报告两名因肝硬化和肝细胞癌接受LT治疗的患者。所开的免疫抑制剂为短期皮质类固醇、他克莫司和霉酚酸酯。一名50岁女性接受LT，供体为其兄弟。LT后她感染了血清学1型HCV；HCV RNA水平为6.0 logIU/mL。皮质类固醇在24天内停用，泼尼松龙（PSL）总剂量为669 mg（调整后）。肝移植后第55天血清丙氨酸氨基转移酶（ALT）水平升至700 U/L。令人惊讶的是，在第87天未检测到HCV RNA。一名52岁男性接受LT，供体为其姐妹。他迅速再次感染血清学2型HCV；HCV RNA水平为6.9 logIU/mL。给予皮质类固醇24天，PSL总剂量为827 mg（调整后）。血清ALT水平持续升高，肝移植后115天其HCV清除。供体和受体均具有主要的IL28B基因型。在未进行干扰素治疗的情况下，停用PSL后，即使在免疫抑制条件下HCV也自发清除。免疫抑制剂的最小化使用和肝炎的存在可能促成了HCV的清除。然而，评估更多相关病例很重要。
