Jung B-H, Park J-I, Lee S-G
Department of Surgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
Department of Surgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
Transplant Proc. 2018 Nov;50(9):2877-2881. doi: 10.1016/j.transproceed.2018.03.057. Epub 2018 Mar 15.
Fibrosing cholestatic hepatitis (FCH) is an aggressive form of hepatitis C virus (HCV) recurrence after liver transplantation (LT). Most FCH cases are fatal, occurring as a secondary disease following rapidly progressive liver dysfunction and graft failure. We report a case of early-onset FCH after LT that was successfully treated using daclatasvir and asunaprevir.
A 59-year-old woman underwent living donor LT for HCV-related liver cirrhosis. However, liver function was not improved after LT and gradually worsened. A liver biopsy was performed at 30 and 47 days after the living donor LT to identify the cause of the liver dysfunction. The first biopsy result showed no specific finding. However, combined treatment with pegylated interferon and ribavirin was started because of a high HCV viral load (> 8.0 log IU/mL). Nevertheless, liver function and HCV viral load deteriorated, and the second biopsy performed on postoperative day 47 revealed FCH. We converted the antiviral agents into daclatasvir and asunaprevir and performed plasmapheresis twice. Since then, the liver dysfunction and HCV viral load gradually improved, and HCV RNA clearance occurred at week 11 after treatment. The patient achieved a sustained virologic response at week 24 after completion of the treatment.
Daclatasvir combined with asunaprevir can be a useful treatment option in potentially fatal FCH after LT.
纤维淤胆型肝炎（FCH）是肝移植（LT）后丙型肝炎病毒（HCV）复发的一种侵袭性形式。大多数FCH病例是致命的，作为快速进展性肝功能障碍和移植物衰竭后的继发疾病出现。我们报告1例肝移植后早发性FCH病例，该病例使用达卡他韦和阿舒瑞韦成功治愈。
一名59岁女性因丙型肝炎病毒相关肝硬化接受活体供肝肝移植。然而，肝移植后肝功能未改善且逐渐恶化。在活体供肝肝移植后第30天和第47天进行肝脏活检以确定肝功能障碍的原因。首次活检结果未发现特异性表现。然而，由于HCV病毒载量高（>8.0 log IU/mL），开始使用聚乙二醇干扰素和利巴韦林联合治疗。尽管如此，肝功能和HCV病毒载量仍恶化，术后第47天进行的第二次活检显示为FCH。我们将抗病毒药物换成达卡他韦和阿舒瑞韦，并进行了两次血浆置换。从那时起，肝功能障碍和HCV病毒载量逐渐改善，治疗后第11周时HCV RNA清除。患者在治疗完成后第24周实现了持续病毒学应答。
达卡他韦联合阿舒瑞韦可能是肝移植后潜在致命性FCH的一种有效治疗选择。
