title: Disappearance of HCV after cessation of immunosuppression in a patient with ulcerative colitis and renal transplantation.
abstract: We report a patient, a 45-year-old Japanese woman, who underwent living-related donor renal transplantation in 1986 and 1988, with the second procedure being successful. Ulcerative colitis (UC) was diagnosed in 1987 while she was receiving immunosuppressive therapy after the renal transplantation. She became positive for serum anti-hepatitis C virus (HCV) in November 1990, although her serum aminotransferase levels were normal. In June 2001, she had frequent episodes of melena with abdominal pain, as control of her UC deteriorated. In July 2001, she was admitted to the Department of Surgery at our hospital, and her daily dose of prednisolone was increased from 40 mg to 80 mg. After 2 weeks of high-dose prednisolone therapy, there was a significant increase of serum aminotransferases, and serum HCV-RNA rose above 850 KIU/ml (by reverse transcription-polymerase chain reaction [RT-PCR]). Control of UC was still poor, so cyclosporine A (CyA) was added at a dose that maintained a high serum concentration. The daily dose of prednisolone was tapered and leukapheresis was performed three times weekly. As result, serum aminotransferases decreased to the normal range. However, total colectomy and colostomy were required because the UC could not be controlled by these therapies. Serum aminotransferase levels increased transiently 2 months after the cessation of immunosuppressive therapy (prednisolone, azathioprine [AZP], and CyA). Subsequently, serum aminotransferases rapidly declined below normal, and the serum level of HCV-RNA (by RT-PCR) fell from 480 KIU/ml to less than 0.5 KIU/ml. She was discharged on April 25, 2002. During follow-up as an outpatient, serum HCV-RNA became negative and remained negative for 7 months. To confirm clearance of HCV, liver biopsy was performed, and no HCV-RNA was detected in the liver tissue by RT-PCR. These findings suggested that HCV was cleared by the cessation of immunosuppressive therapy, as a rebound effect.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University School of Medicine, 6-11-1 Omorinishi, Ota-ku, Tokyo, 143-8541, Japan.
authors.forename: Hidenari
authors.initials: H
authors.lastname: Nagai
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Matsumaru
authors.forename: Kazue
authors.initials: K
authors.lastname: Shiozawa
authors.forename: Kouichi
authors.initials: K
authors.lastname: Momiyama
authors.forename: Noritaka
authors.initials: N
authors.lastname: Wakui
authors.forename: Masao
authors.initials: M
authors.lastname: Shinohara
authors.forename: Manabu
authors.initials: M
authors.lastname: Watanabe
authors.forename: Koji
authors.initials: K
authors.lastname: Ishii
authors.forename: Hiroko
authors.initials: H
authors.lastname: Nonaka
authors.forename: Akira
authors.initials: A
authors.lastname: Hasegawa
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Teramoto
authors.forename: Wataru
authors.initials: W
authors.lastname: Yamamuro
authors.forename: Yasukiyo
authors.initials: Y
authors.lastname: Sumino
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Miki
mesh_terms: D001379:Azathioprine / Q000008:administration & dosage; D003093:Colitis, Ulcerative / Q000150:complications / Q000188:drug therapy*; D005260:Female; D016174:Hepacivirus; D006526:Hepatitis C; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods*; D016030:Kidney Transplantation; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage
chemical_list: D011239:Prednisolone; D001379:Azathioprine