title: Spontaneous clearance of hepatitis C virus after liver transplantation: a report of four cases.
abstract: End-stage liver disease associated with hepatitis C virus (HCV) infection is the leading indication for liver transplantation. Hepatitis C virus infection recurrence in the graft is common under immunosuppression, leading to an accelerated rate of graft failure. We report the clinical features of four of our patients: three patients presenting with spontaneous hepatitis C virus clearance after liver transplantation and one presenting with transient disappearance of hepatitis C virus postoperatively. The transitional period from surgery to hepatitis C virus clearance was <5 months for all patients. The immunosuppression therapy included tacrolimus, mycophenolate mofetil, and corticosteroids. One ABO-incompatible patient presented spontaneous viral clearance postoperatively for the last 5 years. Two patients had episodes of severe bacterial infection, which resulted in a temporary reduction of immunosuppression. Two patients presented with a transient elevation of transaminase preceding spontaneous hepatitis C virus clearance. These clinical findings suggested that factors including surgical stress, severe bacterial infection, and temporary interruption of immunosuppression were correlated with the reactivation of nonspecific immune responses in the hosts, resulting in spontaneous hepatitis C virus clearance postoperatively.
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawara-cho, Shogoin, Sakyo-ku, Kyoto City, Kyoto, 606-8507, Japan. ichiro@kuhp.kyoto-u.ac.jp.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Tamaki
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawara-cho, Shogoin, Sakyo-ku, Kyoto City, Kyoto, 606-8507, Japan. kaido@kuhp.kyoto-u.ac.jp.
authors.forename: Toshimi
authors.initials: T
authors.lastname: Kaido
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawara-cho, Shogoin, Sakyo-ku, Kyoto City, Kyoto, 606-8507, Japan. shintaro@kuhp.kyoto-u.ac.jp.
authors.forename: Shintaro
authors.initials: S
authors.lastname: Yagi
authors.affiliation: Department of Gastroenterology and Hepatology, Kyoto University, 54 Kawara-cho, Shogoin, Sakyo-ku, Kyoto City, Kyoto, 606-8507, Japan. yueda@kuhp.kyoto-u.ac.jp.
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Ueda
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawara-cho, Shogoin, Sakyo-ku, Kyoto City, Kyoto, 606-8507, Japan. etsu@kuhp.kyoto-u.ac.jp.
authors.forename: Etsuro
authors.initials: E
authors.lastname: Hatano
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawara-cho, Shogoin, Sakyo-ku, Kyoto City, Kyoto, 606-8507, Japan. ho1962@kuhp.kyoto-u.ac.jp.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Okajima
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawara-cho, Shogoin, Sakyo-ku, Kyoto City, Kyoto, 606-8507, Japan. uemoto@kuhp.kyoto-u.ac.jp.
authors.forename: Shinji
authors.initials: S
authors.lastname: Uemoto
keywords: Hepatitis C virus; Liver transplantation; Spontaneous clearance