Learning from a rare phenomenon — spontaneous clearance of chronic hepatitis C virus post-liver transplant: A case report

Table 1 Summary of cases of spontaneous hepatitis C clearance post-liver transplant

ID	Ref.	Age (yr)	Sex	Preoperative HCV RNA (IU/mL)	HCV genotype	Rejection episode	Concomitant Issues	Immunosuppression	HCV clearance time
1	Neumann and Neuhaus[20], 2004	54	M	+	1b	1	HAT, retransplant	TAC, MMF, CS	3 mo
2	Samonakis et al[21], 2005	48	M	250000	1a	3	Renal failure	TAC, AZA, CS	75 mo
3	Samonakis et al[21], 2005	55	M	121000	4	3	Renal failure	TAC, AZA, CS	15 mo
4	Bhagat et al[7], 2008	43	M	564000	NA	3	HIV/HAART	MP, TAC, MMF	1 mo
5	Bhagat et al[7], 2008	44	M	450000	NA	3	HIV/HAART	MP, TAC	1 mo
6	Suneetha et al[22], 2008	69	F	+	3a	3	Renal failure/dialysis	MP, Il2a, CSA, CS	12 yr
7	Weber and Trotter[23], 2009	53	M	2.5 million	1a	3	-	TAC, CSA, MMF to CSA	28 mo
8	Dale et al[24], 2009	32	F	3.2 million	NA	1	Dialysis/renal tx	Basiliximuab, TAC, MMF, CS	5 mo
9	Haque et al[19], 2010	66	F	+	2a/2c	3	IVC thrombosis	TAC, MMF, CS	11 mo
10	Seetharam et al[18], 2011	48	M	675000	1	0	-	MP, MMF, CS	2.25 mo
11	Gutiérrez-Moreno et al[26], 2012	38	M	2564	1	0	HIV	CSA, MMF, CS	5 mo
12	Chin et al[12], 2012	40	M	24	1a	1	Alcohol	Daclizumab, TAC, CS, MMF	34 mo
13	Chin et al[12], 2012	41	M	+	1	0	Alcohol	TAC, CS, AZA	9 years
14	Elsiesy et al[25], 2015	32	F	65553	4	0	AIH, DM	FK, CS, CSA, CS	1 mo
15	Urzúa et al[27], 2015	51	M	+	NA	1	Colon Cancer	CSA, MMF, TAC	18 mo
16	Urzúa et al[27], 2015	48	M	280998	3a	0	D2M, alcohol	CSA, IL2a	56 mo
17	Kogiso et al[28], 2015	50	F	19952	1	NA	-	TAC, MMF, MP, CS	Approximately 3 mo
18	Tamaki et al[11], 2015	66	M	199526	1b	0	Sepsis	Rituximab, TAC, MMF, MP, CS	5 mo
19	Tamaki et al[11], 2015	61	M	199	2	Yes	Sepsis	TAC, MMF, MP, CS	3.6 mo
20	Tamaki et al[11], 2015	55	M	125	1b	0	-	TAC, MMF, MP, CS	5.8 mo
21	Tamaki et al[11], 2015	55	M	316227	1b	Yes	-	TAC, MMF, MP, CS	0.5 mo
22	Our Case 1	57	M	+	1a	2	CMV infection	Sirolimus, MMF, CS	15 yr
23	Our Case 2	64	M	+	1	0	Donor HBV core +	TAC, MMF	2 mo
24	Our Case 3	57	M	+	1a	0	Renal tx	TAC, MMF	1 yr

F: Female; M: Male; LT: Liver transplant; NA: Not available; HBV: Hepatitis B virus; HCV: Hepatitis C virus; CMV: Cytomegalovirus; HAT: Hepatic artery thrombosis; HAART: High activity anti-retroviral therapy; IVC: Inferior vena cava; HIV: Human immunodeficiency virus; AIH: Autoimmune hepatitis; DM: Diabetes melilites; MP: Methyl prednisone; AZA: Azathioprine; CSA: Cyclosporine; CS: Corticosteroid; ATG: Anti thymocyte globulin; MMF: Mycophenolate mofetil; Tac: Tacrolimus; IL2a: Interleukin 2 receptor antibody.

Table 2 Factors associated with spontaneous hepatitis C virus clearance

Host factors	Viral factors	Other factors
Younger age	Low viral load (< 1 million IU/mL)	Infection (CMV, HBV, HIV, sepsis)
Female sex		Rejection episode
HLA: DQB1*03, DQB1*03:01, DQB1*11 and DRB1*11:01		Medication related HAART; Withdrawal of immunosuppression
IL28 gene polymorphism		Surgery (transplant, gastrectomy)
Pregnancy

HBV: Hepatitis B virus; CMV: Cytomegalovirus; HAART: High activity anti-retroviral therapy; HIV: Human immunodeficiency virus.