Immune-mediated liver dysfunction after antiviral treatment in liver transplanted patients with hepatitis C: allo or autoimmune de novo hepatitis?
BACKGROUND
The recurrence of hepatitis C after liver transplantation is extremely frequent. Antiviral therapy combining pegylated-interferon with ribavirin is therefore increasingly used in these patients. It has been recently reported, however, that during antiviral treatment a hepatic immune-mediated liver dysfunction, similar to "de novo" autoimmune hepatitis, may develop in a few transplanted patients.


METHODS
Three patients, treated with pegylated-interferon alpha-2a and ribavirin for recurrent hepatitis C after liver transplantation, developed an aggressive hepatitis with clinical, biochemical, and histological features similar to those of autoimmune hepatitis.


RESULTS
In all three patients, a liver enzymes increase was evident after hepatitis C virus-RNA had become undetectable. Diagnosis of "de novo" autoimmune hepatitis was proposed, based on the presence of high-titre circulating autoantibodies and liver histology features. Following the introduction of a steroid therapy, clinical and biochemical parameters progressively improved. Hepatitis C virus infection, however, relapsed after a few months in all the patients.


CONCLUSIONS
Following liver transplantation, antiviral therapy with pegylated-interferon alpha-2a and ribavirin for recurrent hepatitis C may be associated, in a few patients, with severe immune-mediated graft dysfunction similar to autoimmune hepatitis.
Merli
M
M
II Gastroenterologia, Policlinico Umberto I, Università di Roma La Sapienza, Rome, Italy. manuela.merli@uniroma1.it
Gentili
F
F
Giusto
M
M
Attili
A F
AF
Corradini
S G
SG
Mennini
G
G
Rossi
M
M
Corsi
A
A
Bianco
P
P
D000998:Antiviral Agents / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006084:Graft Rejection / Q000139:chemically induced / Q000276:immunology; D016174:Hepacivirus / Q000378:metabolism; D006526:Hepatitis C / Q000097:blood / Q000175:diagnosis / Q000517:prevention & control* / Q000601:surgery*; D019693:Hepatitis, Autoimmune / Q000276:immunology*; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000008:administration & dosage / Q000009:adverse effects*; D008099:Liver / Q000187:drug effects / Q000473:pathology; D016031:Liver Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000008:administration & dosage / Q000009:adverse effects*; D012367:RNA, Viral / Q000097:blood; D011994:Recombinant Proteins; D055502:Secondary Prevention; D012720:Severity of Illness Index
D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D012367:RNA, Viral; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; C100416:peginterferon alfa-2a