title: Liver transplantation for fulminant genotype 2a/c hepatitis C virus marked by a rapid recurrence followed by cure.
abstract: Although chronic hepatitis C is still the leading indication for liver transplantation (LT) in the United States and Europe, acute liver failure caused by hepatitis C is distinctly uncommon and transplantation for fulminant hepatitis C virus (HCV) has not been documented in the United States. We present a case report of fulminant hepatic failure caused by genotype 2a/c HCV not only treated with LT but also complicated by severe, rapid recurrence of HCV within 6 days of transplantation. The risk factor for the initial infection was likely sexual, and there were no explanations for acute hepatitis post-transplant other than recurrent hepatitis C. Treatment with all-oral direct antiviral agents was swiftly initiated during the index hospitalization, leading to resolution of the acute hepatitis and resulting in sustained virologic response. It can only be speculated whether this was an infection with the JFH-1 strain or another similarly virulent genotype 2a/c HCV infection.
authors.affiliation: Department of Surgery, Memorial University Medical Center, Savannah, GA, USA.
authors.forename: Brett
authors.identifier: http://orcid.org/0000-0002-1469-3608
authors.initials: B
authors.lastname: Tracy
authors.affiliation: Department of Transplantation, Piedmont Transplant Institute, Atlanta, GA, USA.
authors.forename: Roshan
authors.initials: R
authors.lastname: Shrestha
authors.affiliation: Department of Transplantation, Piedmont Transplant Institute, Atlanta, GA, USA.
authors.forename: Lance
authors.initials: L
authors.lastname: Stein
authors.affiliation: Department of Transplantation, Piedmont Transplant Institute, Atlanta, GA, USA.
authors.forename: Devina
authors.initials: D
authors.lastname: Bhasin
authors.affiliation: Department of Transplantation, Piedmont Transplant Institute, Atlanta, GA, USA.
authors.forename: Harrison
authors.initials: H
authors.lastname: Pollinger
authors.affiliation: Department of Transplantation, Piedmont Transplant Institute, Atlanta, GA, USA.
authors.forename: Raymond A
authors.initials: RA
authors.lastname: Rubin
mesh_terms: D000208:Acute Disease; D000284:Administration, Oral; D000998:Antiviral Agents / Q000627:therapeutic use*; D002219:Carbamates; D004359:Drug Therapy, Combination; D005838:Genotype; D016174:Hepacivirus / Q000235:genetics* / Q000302:isolation & purification; D006526:Hepatitis C / Q000097:blood / Q000150:complications / Q000235:genetics / Q000628:therapy*; D006801:Humans; D007093:Imidazoles / Q000627:therapeutic use; D017114:Liver Failure, Acute / Q000097:blood / Q000601:surgery*; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011759:Pyrrolidines; D012008:Recurrence; D012254:Ribavirin / Q000627:therapeutic use; D012307:Risk Factors; D000069474:Sofosbuvir / Q000627:therapeutic use; D014633:Valine / Q000031:analogs & derivatives
chemical_list: D000998:Antiviral Agents; D002219:Carbamates; D007093:Imidazoles; D011759:Pyrrolidines; D012254:Ribavirin; D014633:Valine; C549273:daclatasvir; D000069474:Sofosbuvir
keywords: acute liver failure; fulminant hepatic failure; genotype 2a/c HCV; hepatitis C virus; liver transplantation; sustained virologic response