Antiviral therapy of symptomatic HCV-mixed cryoglobulinemia after liver transplant

Case report and literature review

Maria Francesca Donato, Giovanni Banfi, Donata Cresseri, G. Battista Fogazzi, Paul Martin, Piergiorgio Messa, Fabrizio Fabrizi

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Hepatitis C virus (HCV) infection may be associated with extra-hepatic illness including mixed cryoglobulinemia (MC). Consistent evidence exists on HCV-MC in the non-transplantation setting but information on HCV-related cryoglobulinemia after solid organ transplantation is limited, particularly after liver transplantation (LT). We report on a 48-year-old man who developed HCV-associated cryoglobulinemic vasculitis with recurrent hepatitis after liver transplant. One year after transplant for HCV-positive cirrhosis, he presented severe cutaneous manifestations, and biopsy-proven cryoglobulinemic membrano- proliferative glomerulonephritis (MPGN). HCV RNA clearance occurred within a few weeks of antiviral therapy; sustained viral response (SVR) was obtained by one year of anti-HCV combination therapy (eight months of pegylated IFN/ribavirin and four months of standard IFN/ribavirin). SVR was linked to complete remission of skin, liver, and kidney abnormalities. Tolerance to the pegylated IFN/ ribavirin regimen was not excellent due to the occurrence of lobar pneumonia with anemia; thus, peg-IFN was replaced by recombinant IFN, with a favorable outcome. Clinical and viral remission persisted over a 48-month follow-up. HCV-associated mixed cryoglobulinemia flareups following LT were successfully managed with combined antiviral therapy. HCV-related MC is uncommon in developed countries and this clearly hampers randomized controlled clinical trials aimed at evaluating the efficacy and safety of anti-HCV therapy after solid organ transplantation or in the non-transplantation setting.

Original languageEnglish
Pages (from-to)367-372
Number of pages6
JournalInternational Journal of Artificial Organs
Volume36
Issue number5
DOIs
Publication statusPublished - May 2013

Fingerprint

Cryoglobulinemia
Transplants
Viruses
Hepacivirus
Liver
Antiviral Agents
Transplantation (surgical)
Ribavirin
Therapeutics
Organ Transplantation
Liver Transplantation
Membranoproliferative Glomerulonephritis
Skin Manifestations
Biopsy
Virus Diseases
Vasculitis
RNA
Developed Countries
Hepatitis
Anemia

Keywords

  • Hepatitis C
  • Interferon
  • Liver transplant
  • Mixed cryoglobulinemia
  • Ribavirin

ASJC Scopus subject areas

  • Biomaterials
  • Biomedical Engineering
  • Bioengineering
  • Medicine (miscellaneous)

Cite this

Antiviral therapy of symptomatic HCV-mixed cryoglobulinemia after liver transplant : Case report and literature review. / Donato, Maria Francesca; Banfi, Giovanni; Cresseri, Donata; Battista Fogazzi, G.; Martin, Paul; Messa, Piergiorgio; Fabrizi, Fabrizio.

In: International Journal of Artificial Organs, Vol. 36, No. 5, 05.2013, p. 367-372.

Research output: Contribution to journalArticle

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