title: Spontaneous clearance of hepatitis C genotype 4 after liver retransplantation.
abstract: BACKGROUND
  Hepatitis C virus (HCV)-related cirrhosis remains the most common indication for liver transplantation worldwide. Graft reinfection with HCV is nearly universal, causing significant morbidity and mortality. Spontaneous clearance of HCV after liver transplantation and retransplantation is extremely rare. We report a case of spontaneous clearance of HCV genotype 4 that occurred shortly after 2nd liver transplantation.
  
  
  METHODS
  A 32-year-old female patient received a cadaveric liver transplant for HCV-related cirrhosis in 2007. She was not treated for HCV before transplantation. The patient developed biopsy-proven HCV recurrence with elevated transaminases and 65,553 IU/mL HCV RNA, genotype 4. She could not tolerate interferon-based treatment. The patient's condition progressively worsened and required a 2nd cadaveric liver transplantation in March 2013. Immunosuppression initially included steroids and Prograf, which was then switched to cyclosporine after the patient developed seizure. She developed acute cellular rejection which was readily treated with immunosuppression adjustment. HCV RNA became negative in April, which was confirmed in May 2013.
  
  
  CONCLUSIONS
  Spontaneous clearance of hepatitis C rarely occurs after liver transplantation and is extremely rare after retransplantation. This finding may be explained by alterations in the host immune responses to HCV after transplantation. To our knowledge, this is the first case of spontaneous clearance of HCV genotype 4 after liver retransplantation.
authors.affiliation: Department of Liver and Small Bowel Transplantation and Hepatic-Biliary-Pancreatic Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. Electronic address: haelsiesy@kfshrc.edu.sa.
authors.forename: H
authors.initials: H
authors.lastname: Elsiesy
authors.affiliation: Department of Liver and Small Bowel Transplantation and Hepatic-Biliary-Pancreatic Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
authors.forename: F
authors.initials: F
authors.lastname: Abaalkhail
authors.affiliation: Department of Liver and Small Bowel Transplantation and Hepatic-Biliary-Pancreatic Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
authors.forename: M
authors.initials: M
authors.lastname: Al Sebayel
authors.affiliation: Organ Transplant Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
authors.forename: D
authors.initials: D
authors.lastname: Broering
authors.affiliation: Department of Liver and Small Bowel Transplantation and Hepatic-Biliary-Pancreatic Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; Department of Gastroenterology, King Saud University Riyadh, KSA.
authors.forename: W
authors.initials: W
authors.lastname: Al Hamoudi
authors.affiliation: Department of Liver and Small Bowel Transplantation and Hepatic-Biliary-Pancreatic Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; School of Medicine, Ahfad University for Women, Omdurman, Sudan.
authors.forename: S
authors.initials: S
authors.lastname: Yousif
authors.affiliation: Department of Surgery, Al Faisal University, Riyadh, KSA.
authors.forename: W
authors.initials: W
authors.lastname: Al-Kattan
authors.affiliation: Department of Liver and Small Bowel Transplantation and Hepatic-Biliary-Pancreatic Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
authors.forename: K
authors.initials: K
authors.lastname: Selim
mesh_terms: D000328:Adult; D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D005838:Genotype; D006084:Graft Rejection / Q000517:prevention & control; D016174:Hepacivirus / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000150:complications / Q000276:immunology* / Q000821:virology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000209:etiology / Q000601:surgery*; D016031:Liver Transplantation; D012367:RNA, Viral / Q000097:blood*; D012008:Recurrence; D012075:Remission, Spontaneous; D012086:Reoperation
chemical_list: D007166:Immunosuppressive Agents; D012367:RNA, Viral; D016572:Cyclosporine