Recurrent allograft HCV presenting as acute cellular rejection: successful management with interferon and ribavirin alone.

Details

Serval ID
serval:BIB_9E2C86C90013
Type
Article: article from journal or magazin.
Collection
Publications
Title
Recurrent allograft HCV presenting as acute cellular rejection: successful management with interferon and ribavirin alone.
Journal
Clinical Transplantation
Author(s)
Leung J.Y., Abraczinskas D.R., Bhan A.K., Terella A.M., Pascual M., Cosimi A.B., Chung R.T.
ISSN
0902-0063[print], 0902-0063[linking]
Publication state
Published
Issued date
2003
Volume
17
Number
3
Pages
275-283
Language
english
Notes
Publication types: Case Reports ; Journal Article
Abstract
Hepatitis C virus (HCV) is currently the leading indication worldwide for orthotopic liver transplantation. However, the majority of patients receiving transplant for HCV eventually develop histopathologic evidence of recurrent allograft HCV and approximately 10% die or require retransplantation within the first 5 post-operative years because of accelerated graft injury and cirrhosis. Traditional induction immunosuppressive regimens and intensive immunosuppression used to treat episodes of acute cellular rejection (ACR) are associated with enhanced viral replication and higher likelihood and severity of recurrent HCV. At our institution, therefore, we have used low-dose steroid therapy in an effort to limit HCV replication. However, this practice has been associated with frequent early presentations consistent with ACR. Here, we present three cases consistent with histologic ACR treated with conventional antirejection therapy that improved transiently, but evolved rapidly to progressive HCV. A fourth patient with a similar presentation experienced dramatic improvement in aminotransferases when treated solely with interferon and ribavirin. We propose that histologic characteristics traditionally associated with ACR may, in fact, represent early recurrent HCV as both processes share common immunopathogenetic mechanisms, or alternatively, that both ACR and recurrent HCV may be present simultaneously. We conclude that in cases suggestive of ACR, careful consideration should be given to treatment for recurrent HCV in lieu of or in concert with intensive immunosuppression.
Keywords
Acute Disease, Adult, Aged, Antiviral Agents/therapeutic use, Aspartate Aminotransferases/blood, Female, Glucocorticoids/therapeutic use, Graft Rejection/drug therapy, Graft Rejection/etiology, Hepatitis C/complications, Hepatitis C/drug therapy, Humans, Immunosuppressive Agents/therapeutic use, Interferon Alfa-2b/therapeutic use, Liver Transplantation, Male, Middle Aged, Prednisolone/therapeutic use, Recurrence, Ribavirin/therapeutic use
Pubmed
Web of science
Create date
29/01/2008 13:52
Last modification date
20/08/2019 15:04
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