Mitchell Robert A, Hussaini Trana, Yau Alan H, Krajden Mel, Wright Alissa J, Scudamore Charles H, Marquez Azalgara Vladimir, Erb Siegfried R, Yoshida Eric M
Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada.
Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.
Transplant Direct. 2018 Feb 2;4(3):e347. doi: 10.1097/TXD.0000000000000763. eCollection 2018 Mar.
The goal of treating chronic hepatitis C virus (HCV) infection is sustained virologic response (SVR). There is concern that despite achieving SVR, replication-competent HCV may be sequestered at low levels within the liver and could theoretically reactivate with immunosuppression. We report transplantation of a HCV-seropositive liver donor, who achieved SVR, into a seronegative patient without HCV reactivation despite profound immunosuppression.
Retrospective chart review.
We present a 21-year-old male who was HCV seronegative and received a liver transplant from a donor who had been treated for HCV and achieved SVR. The liver recipient, despite developing severe acute graft rejection and undergoing intense immunosuppression with T cell-depleting antibodies, did not become HCV RNA-positive with a follow up period of 8 months. The recipient was HCV seronegative before transplant, but became HCV seropositive immediately posttransplant. The antibodies were undetectable after 97 days, in keeping with a passive antibody transmission or B lymphocyte transmission with the graft.
To the best of our knowledge, this is the first reported case of an HCV seropositive liver allograft transplanted into an HCV-negative recipient who subsequently received intense immunosuppression. This case, therefore, is an encouraging and novel step in liver transplantation, and demonstrates that SVR may be closer to a true "cure" of HCV in the donor population and that, even in circumstances of very potent immunosuppression in the recipient, this SVR is sustained.
治疗慢性丙型肝炎病毒（HCV）感染的目标是实现持续病毒学应答（SVR）。有人担心，尽管实现了SVR，但具有复制能力的HCV可能会以低水平隐匿于肝脏内，理论上可能会因免疫抑制而重新激活。我们报告了将一名实现SVR的HCV血清学阳性肝脏供体移植给一名血清学阴性患者，尽管该患者接受了深度免疫抑制，但并未出现HCV重新激活的情况。
回顾性病历审查。
我们介绍了一名21岁的男性，他HCV血清学阴性，接受了一名曾接受HCV治疗并实现SVR的供体的肝脏移植。肝脏受体尽管发生了严重的急性移植物排斥反应，并接受了使用耗竭T细胞抗体的强化免疫抑制治疗，但在8个月的随访期内并未出现HCV RNA阳性。受体在移植前HCV血清学阴性，但在移植后立即变为HCV血清学阳性。97天后抗体检测不到，这与被动抗体传递或随移植物的B淋巴细胞传递一致。
据我们所知，这是首次报道将HCV血清学阳性肝脏同种异体移植物移植到HCV阴性受体，该受体随后接受了强化免疫抑制治疗的病例。因此，该病例是肝脏移植中一个令人鼓舞的新进展，表明SVR可能更接近供体人群中HCV的真正“治愈”，并且即使在受体接受非常强效免疫抑制的情况下，这种SVR仍能持续。
