Ismail B, Benrajab KM, Bejarano P, Ruiz P, Sears D, Tzakis A, Zervos XB. Benign course of residual inflammation at end of treatment of liver transplant recipients after sofosbuvir based therapy. World J Hepatol 2022; 14(3): 602-611 [PMID: 35582292 DOI: 10.4254/wjh.v14.i3.602]
Corresponding Author of This Article
Karim M Benrajab, MD, Assistant Professor, Internal Medicine/Division of Digestive Diseases and Nutrition, University of Kentucky College of Medicine, 770 Rose Street, MN649, Lexington, KY 40536, United States. karimbenrajab@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Mar 27, 2022; 14(3): 602-611 Published online Mar 27, 2022. doi: 10.4254/wjh.v14.i3.602
Benign course of residual inflammation at end of treatment of liver transplant recipients after sofosbuvir based therapy
Bahaaeldeen Ismail, Karim M Benrajab, Pablo Bejarano, Phillip Ruiz, Debbie Sears, Andreas Tzakis, Xaralambos Bobby Zervos
Bahaaeldeen Ismail, Karim M Benrajab, Division of Digestive Diseases and Nutrition, University of Kentucky College of Medicine, Lexington, KY 40536, United States
Pablo Bejarano, Department of Pathology, Cleveland Clinic Florida, Weston, FL 33331, United States
Phillip Ruiz, Department of Pathology, University of Miami Miller School of Medicine, Miami, FL 33136, United States
Debbie Sears, Andreas Tzakis, Xaralambos Bobby Zervos, Department of Liver Transplant, Cleveland Clinic Florida, Weston, FL 33331, United States
Author contributions: Zervos XB and Tzakis A designed the research; Ismail B, Sears D performed the research; Ismail B, Bejarano P, Ruiz P analyzed the data; Sears D, Benrajab KM, Ismail B, and Zervos XB wrote the paper; all authors contributed to critical revision of the manuscript, and saw and approved the final version.
Institutional review board statement: The study was reviewed and approved by Cleveland Clinic Institutional Review Board.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: Authors have no relevant relationships or conflict of interest to disclose.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Karim M Benrajab, MD, Assistant Professor, Internal Medicine/Division of Digestive Diseases and Nutrition, University of Kentucky College of Medicine, 770 Rose Street, MN649, Lexington, KY 40536, United States. karimbenrajab@gmail.com
Received: October 23, 2021 Peer-review started: October 23, 2021 First decision: December 2, 2021 Revised: December 16, 2021 Accepted: February 15, 2022 Article in press: February 15, 2022 Published online: March 27, 2022 Processing time: 151 Days and 23 Hours
Abstract
BACKGROUND
Persistent inflammation on histology after successful hepatitis C (HCV) treatment has been reported. However, data regarding the long-term impact in liver transplant recipients is limited, particularly after using direct-acting antiviral (DAA) therapies.
AIM
To evaluate the impact of successful treatment with DAAs on histological changes and occult HCV and to describe the clinical course of residual inflammation in liver transplant recipients.
METHODS
We conducted a case series of 13 chronic HCV infected liver transplant recipients successfully treated with DAAs between December 2013 and May 2014. All patients were treated for 24 wk and had non-detectable serum HCV RNA by the time of biopsy. Only patients with at least one liver biopsy at or after treatment were included. We examined liver biopsies for evidence of residual inflammation and the presence of intrahepatic HCV RNA.
RESULTS
Persistent inflammation was seen in 12/13 patients on end of treatment biopsy. Inflammation was still seen in the available five follow-up biopsies (range 38-48 wk after the end of treatment). Intrahepatic HCV RNA was undetectable in all biopsies. All patients had preserved graft function for a mean follow-up of 2.5 years, except one that developed chronic rejection.
CONCLUSION
After successful HCV treatment with DAAs, liver transplant recipients may have persistent inflammation on biopsy without evidence of intracellular RNA. The clinical outcome remained favorable in most patients. Further studies with a larger number and longer follow-up are needed to establish the implication of this finding on long-term graft function.
Core Tip: Unexplained residual inflammation can be seen in a subset of liver transplant recipients successfully treated with direct-acting antiviral therapies; however, it does not seem to affect graft function. An extensive clinical and histopathologic workup should still be performed to exclude other potentially treatable conditions.
