Acute Graft Rejection and Formation of De Novo Donor-Specific Antibodies Triggered by Low Cyclosporine Levels and Interferon Therapy for Recurrent Hepatitis C Infection After Liver Transplantation: A Case Report.

Abstract

BACKGROUND:

We report a case of acute rejection of a liver graft, together with the occurrence of de novo donor-specific antibodies (DSAs), in a 53-year-old Japanese man who had undergone deceased-donor liver transplantation.

METHODS:

The graft rejection was triggered by low cyclosporine levels and pegylated interferon treatment for the recurrence of hepatitis C virus (HCV) infection 18 months after transplantation. Although the graft was ABO-compatible, pre-formed DSA B51 was detected; therefore, total plasma exchange was performed and intravenous rituximab (500 mg/body) was administered before transplantation.

RESULTS:

DSA was absent 6 months after transplantation. HCV recurrence was treated with pegylated interferon-α-2a. Renal function deteriorated with this anti-HCV therapy, with serum cyclosporine levels decreasing to 50 ng/mL. A rapid virologic response was achieved, but liver function deteriorated after 3 months of anti-HCV therapy, with histologic evidence of acute cellular rejection and formation of de novo DSAs. Anti-thymocyte globulin was administered for 5 days, which led to immediate improvement in liver function. However, renal function declined, warranting hemodialysis. The patient recovered 2 months after acute rejection, although de novo DSAs persisted.

CONCLUSIONS:

Careful immunologic monitoring may be required for patients receiving interferon therapy for HCV infection to maintain sufficient blood levels of immunosuppressive agents and to prevent acute liver graft rejection.

• Authors: R Nakano, M Ohira, K Ishiyama, K Ide, T Kobayashi, H Tahara, S Shimizu, K Arihiro, M Imamura, K Chayama, Y Tanaka, H Ohdan
• Journal: Transplantation proceedings (Transplant Proc) Vol. 49 Issue 7 Pg. 1634-1638 (Sep 2017) ISSN: 1873-2623 [Electronic] United States
• PMID: 28838454 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2017 Elsevier Inc. All rights reserved.

Chemical References

• Antibodies
• Antilymphocyte Serum
• Antiviral Agents
• Cyclosporins
• Immunosuppressive Agents
• Interferon-alpha
• Recombinant Proteins
• Polyethylene Glycols
• peginterferon alfa-2a

Topics

• Antibodies (immunology)
• Antibody Specificity
• Antilymphocyte Serum (therapeutic use)
• Antiviral Agents (adverse effects)
• Cyclosporins (blood)
• Graft Rejection (blood, chemically induced, immunology)
• Hepacivirus (immunology)
• Hepatitis C, Chronic (drug therapy, virology)
• Humans
• Immunosuppressive Agents (blood)
• Interferon-alpha (adverse effects)
• Liver Transplantation (adverse effects)
• Male
• Middle Aged
• Monitoring, Immunologic
• Plasmapheresis
• Polyethylene Glycols (adverse effects)
• Postoperative Complications (drug therapy, virology)
• Recombinant Proteins (adverse effects)
• Recurrence
• Tissue Donors