Success of early antiviral monotherapy with pegylated interferon α-2a for posttransplantation fibrosing cholestatic hepatitis C (a clinical case)

The paper describes a case of posttransplantation fibrosing cholestatic hepatitis C (PFCHC) in a female patient whose transplant was preserved due to timely antiviral therapy (AVT). Its differential diagnosis primarily required that chronic graft rejection and biliary anastomotic stricture be excluded as a cause of dysfunction. PFCHC was proposed to be a possible cause of graft dysfunction on the basis of the clinical course of the disease, the presence of a very high viral load, intervals after orthotopic liver transplantation, the results of histological studies, and no signs of biliary hypertension. Antiviral monotherapy was initiated using pegylated interferon α-2a (Pegasys), which resulted in a considerable improvement and yielded complete early virological and biochemical responses to AVT. This allows one to hope to obtain a sustained virological response and to eliminate hepatitis C infection in the patient after termination of a 48-week course of therapy.

1. Terrault N.A., Berenguer M. Treating hepatitis C infection in liver transplant recipients. Liver transplant 2006;12(8):1192–204.

2. Сюткин В.Е., Андрейцева О.И., Чжао А.В. Дисфункция трансплантата печени, обусловленная инфекцией гепатита С. Трансплантология 2010; (3–4): 37–45.

3. Haque M., Hashim A., Greanya E.D. et al. Spontaneous clearance of hepatitis C infection post-liver transplant: A rare but real phenomenon? A case report and review of the literature. Annals of hepatology 2010;9(2):202–6.

4. Narang T.K., Ahrens W., Russo M.W. Post-liver transplant cholestatic hepatitis C: a systematic review of clinical and pathological findings and application of consensus criteria. Liver transplantation: official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, 2010;16(11):1228–35.

5. Davies S.E., Portmann B.C., Grady J.G. et al. Hepatic histological findings after transplantation for chronic hepatitis B virus infection, including a unique pattern of fibrosing cholestatic hepatitis. Hepatology 1991;13(1):150–7.

6. Adeyi O., Fischer S.E., Guindi M. Liver allograft pathology: approach to interpretation of needle biopsies with clinicopathological correlation. J Clin Pathology 2010;63(1):47–74.

7. Wiesner R.H., Sorrell M., Villamil F. Report of the first International Liver Transplantation Society expert panel consensus conference on liver transplantation and hepatitis C. Liver transpl 2003;9(11):1–9.

8. Honda M., Kaneko S., Matsushita E. et al. Cell cycle regulation of hepatitis C virus internal ribosomal entry sitedirected translation. Gastroenterology 2000;118(1):152–62.

9. Zekry A., Bishop G.A., Bowen D.G. et al. Intrahepatic cytokine profiles associated with posttransplantation hepatitis C virus-related liver injury. Liver Transpl 2002;8(3):292–301.