Document Detail

Immune-mediated liver dysfunction after antiviral treatment in liver transplanted patients with hepatitis C: allo or autoimmune de novo hepatitis?
MedLine Citation:
PMID:  19162574     Owner:  NLM     Status:  MEDLINE    
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. PATIENTS AND 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.
M Merli; F Gentili; M Giusto; A F Attili; S G Corradini; G Mennini; M Rossi; A Corsi; P Bianco
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2009-01-21
Journal Detail:
Title:  Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver     Volume:  41     ISSN:  1878-3562     ISO Abbreviation:  Dig Liver Dis     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-04-03     Completed Date:  2009-06-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100958385     Medline TA:  Dig Liver Dis     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  345-9     Citation Subset:  IM    
II Gastroenterologia, Policlinico Umberto I, Università di Roma La Sapienza, Rome, Italy.
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MeSH Terms
Antiviral Agents / administration & dosage,  adverse effects*
Graft Rejection / chemically induced,  immunology
Hepacivirus / metabolism
Hepatitis C / blood,  diagnosis,  prevention & control*,  surgery*
Hepatitis, Autoimmune / immunology*
Interferon Alfa-2a / administration & dosage,  adverse effects*
Liver / drug effects,  pathology
Liver Transplantation / immunology*
Middle Aged
Polyethylene Glycols / administration & dosage,  adverse effects*
RNA, Viral / blood
Recurrence / prevention & control
Severity of Illness Index
Reg. No./Substance:
0/Antiviral Agents; 0/Polyethylene Glycols; 0/RNA, Viral; 0/peginterferon alfa-2a; 76543-88-9/Interferon Alfa-2a

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