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A Case Report of Alloimmune Hepatitis after Direct-acting Antiviral Treatment in a Liver Transplant Patient

Catherine Choi, Youssef Botros, Jamil Shah, Pei Xue, Anja Jones, Mark Galan, Raquel Olivo, Mumtaz Niazi, Flavio Paterno, James Guarrera, Nikolaos T. Pyrsopoulos
Journal of Clinical and Translational Hepatology , Volume 8, pp 1-4; doi:10.14218/jcth.2020.00062

Abstract: Direct-acting antiviral (DAA) therapy is often well-tolerated, and adverse events from DAA therapy are uncommon. We report a case of a woman who underwent orthotopic liver transplant for chronic hepatitis C infection and later developed alloimmune hepatitis shortly after starting DAA therapy for recurrent hepatitis C infection. The patient developed acute alloimmune hepatitis approximately 2 weeks after starting treatment with sofosbuvir, velpatasvir, and voxilaprevir. This case report proposes a dysregulation of immune surveillance due to the DAA stimulation of host immunity and rapid elimination of hepatitis C viral load as a precipitating factor for the alloimmune process, leading to alloimmune hepatitis in a post-transplant patient who starts on DAA.
Keywords: Treatment / Antiviral / viral load / case report / liver transplant / DAA / tolerated / Alloimmune Hepatitis

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