Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Feb 27, 2022; 14(2): 456-463
Published online Feb 27, 2022. doi: 10.4254/wjh.v14.i2.456
Learning from a rare phenomenon — spontaneous clearance of chronic hepatitis C virus post-liver transplant: A case report
Noreen Singh, Mang Ma, Aldo J Montano-Loza, Rahima A Bhanji
Noreen Singh, Mang Ma, Aldo J Montano-Loza, Rahima A Bhanji, Division of Gastroenterology and Liver Unit, University of Alberta Hospital, Edmonton T6G 2X8, Alberta, Canada
Author contributions: All authors contributed to the writing of the manuscript, critical revision and approval of the final manuscript.
Informed consent statement: Informed written consent was obtained from the patients for publication of this report.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE checklist (2016), and the manuscript was prepared and revised according to the CARE checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Rahima A Bhanji, FRCPC, MD, MSc, Associate Professor, Attending Doctor, Division of Gastroenterology and Liver Unit, University of Alberta Hospital, 8540 112 Street NW, Zeidler Ledcor Centre, Room 1-24B, Edmonton T6G 2X8, Alberta, Canada. rbhanji@ualberta.ca
Received: January 6, 2021
Peer-review started: January 6, 2021
First decision: February 13, 2021
Revised: February 26, 2021
Accepted: February 9, 2022
Article in press: February 9, 2022
Published online: February 27, 2022
Abstract
BACKGROUND

Hepatitis C virus (HCV) can lead to chronic liver damage resulting in cirrhosis and hepatocellular carcinoma. Spontaneous clearance of HCV has been documented after an acute infection in 20%-45% of individuals. However, spontaneously resolved chronic hepatitis C following liver transplant (LT) is rare and has been documented only in a few case reports. The phenomenon of spontaneous clearance of chronic hepatitis C occurs together with other meaningful events, which are typically associated with significant changes in the host immunity.

CASE SUMMARY

We report three cases of spontaneous resolution of chronic hepatitis C following liver transplantation. These patients either failed or had no HCV treatment prior to transplant, but had spontaneous resolution of HCV post-LT as documented by undetectable polymerase chain reaction (PCR). Diagnosis of HCV was based on viremia through PCR or liver biopsy. All three patients currently undergo surveillance and have no recurrence of HCV.

CONCLUSION

Examining each patient’s clinical course, we learned about many viral, host and cellular-factors that may have enhanced the host’s immunity leading to spontaneous clearance of HCV. Though HCV treatment has excellent cure rates, understanding this mechanism may provide clinicians with insights regarding timing and duration of treatment.

Keywords: Spontaneous resolution of hepatitis C, Liver transplantation, Hepatitis C, Immunosuppression, Viral load, Case report

Core Tip: Spontaneous resolution of chronic hepatitis C virus (HCV) following liver transplant is a rare phenomenon. In this case report, we examined three cases and completed a literature review thereby examining thirty cases. Spontaneous resolution may be related to host, viral and other factors resulting in enhancement of the host’s immunity. Host factors include younger age, female sex, HLA, DQBI, IL28 gene and pregnancy. Viral factors include a low viral load. Lastly, other factors include infections, rejection episodes, medications, and surgery. Even though HCV treatment is excellent, understanding this phenomenon will be beneficial to determine timing and duration of treatment.