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,...Continue Reading
References
Jul 1, 1992·Gastroenterology·T L WrightN L Ascher
Aug 6, 1988·Lancet·J G O'GradyR Williams
Jan 1, 1995·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·P A SheinerC M Miller
Apr 1, 1994·Gastroenterology·O ChazouilleresM Urdea
Jan 1, 1996·Gastroenterology·E J GaneR Williams
Mar 28, 1996·The New England Journal of Medicine·E J GaneR Williams
Oct 1, 1996·Current Opinion in Immunology·H Auchincloss, H Sultan
Sep 10, 1998·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·M CharltonJ Hoofnagle
Nov 27, 1998·European Journal of Gastroenterology & Hepatology·M PrietoJ I Herrero
Mar 30, 1999·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·J E EverhartJ H Hoofnagle
Nov 7, 1999·Journal of Hepatology·P CacoubJ C Piette
Jan 10, 2002·The Journal of Experimental Medicine·Stefania CrottaNicholas M Valiante
Jan 10, 2002·The Journal of Experimental Medicine·Chien-Te K Tseng, Gary R Klimpel
Feb 2, 2002·The Journal of Immunology : Official Journal of the American Association of Immunologists·Mark A ExleyMargaret J Koziel
Jul 10, 2002·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·M Charlton
Citations
Mar 25, 2014·World Journal of Gastroenterology : WJG·Francesco VasuriAntonia D'Errico-Grigioni
Dec 6, 2006·Human Immunology·Alfredo MinguelaMaria R Alvarez-López
Jan 3, 2006·Transplantation Proceedings·G W NeffK Rajender Reddy
Feb 22, 2011·Transplantation Proceedings·F R PonzianiS Fagiuoli
Mar 6, 2015·Memórias do Instituto Oswaldo Cruz·Alice Tung Wan SongEdson Abdala
Apr 24, 2004·The American Journal of Surgical Pathology·A J DemetrisT E Starzl