title: Antimitochondrial antibody serocoversion post-liver transplant during hepatitis C treatment with peginterferon α, ribavirin and telaprevir.
abstract: Pegylated interferon alpha (PEG-IFN α), a key component of chronic hepatitis C therapy, has been linked to the development of auto-antibodies and autoimmune disease. We report the first case of antimitochondrial antibody (AMA) seroconversion during PEG-INF α based therapy after liver.1-4 transplantation. A fiftyseven year-old man five months after liver transplantation was initiated on hepatitis C triple therapy with PEG-INF α, ribavirin and telaprevir. He had failed previous PEG-IFN α and ribavirin 12 years pre-transplant and his AMA remained negative pre-transplant. After twelve weeks of antiviral therapy, he developed elevated liver enzyme tests associated with an AMA seroconversion to seropositivity. A liver biopsy failed to show histological evidence of primary biliary cirrhosis or graft rejection. He was initiated on urseodeoxycholic acid with subsequent improvement of his liver enzymes. This case demonstrates that despite adequate immunosuppression, AMA seroconversion may occur post-transplant during interferon-based therapy. As AMA seroconversion did not occur during the pre-transplant PEG-IFN therapy, we speculate that donor allograft antigens in combination with PEG-IFN may have been a factor in the post-transplant seroconversion.
authors.affiliation: Division of Gastroenterology. University of British Columbia. Canada.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Marquez-Azalgara
authors.affiliation: Faculty of Pharmaceutical Science. University of British Columbia. Canada.
authors.forename: Trana
authors.initials: T
authors.lastname: Hussaini
authors.affiliation: Division of Gastroenterology. University of British Columbia. Canada.
authors.forename: Siegfried R
authors.initials: SR
authors.lastname: Erb
authors.affiliation: Faculty of Pharmaceutical Science. University of British Columbia. Canada.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Yoshida
mesh_terms: D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001323:Autoantibodies / Q000097:blood*; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000601:surgery* / Q000821:virology; D004359:Drug Therapy, Combination; D016174:Hepacivirus / Q000187:drug effects / Q000276:immunology / Q000472:pathogenicity; D019698:Hepatitis C, Chronic / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016898:Interferon-alpha / Q000009:adverse effects / Q000627:therapeutic use*; D008113:Liver Neoplasms / Q000175:diagnosis / Q000601:surgery* / Q000821:virology; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D008928:Mitochondria / Q000276:immunology*; D009842:Oligopeptides / Q000627:therapeutic use*; D011092:Polyethylene Glycols / Q000009:adverse effects / Q000627:therapeutic use*; D012254:Ribavirin / Q000627:therapeutic use*; D016896:Treatment Outcome; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use
chemical_list: D000998:Antiviral Agents; D001323:Autoantibodies; D007166:Immunosuppressive Agents; D016898:Interferon-alpha; D009842:Oligopeptides; D011092:Polyethylene Glycols; D012254:Ribavirin; C486464:telaprevir; D014580:Ursodeoxycholic Acid