Immunoglobulin G4-associated de novo autoimmune hepatitis after liver transplantation for chronic hepatitis B- and C-related cirrhosis and hepatocellular carcinoma: a case report with literature review.

Publisher: Elsevier Science Inc Country of Publication: United States NLM ID: 0243532 Publication Model: Print Cited Medium: Internet ISSN: 1873-2623 (Electronic) Linking ISSN: 00411345 NLM ISO Abbreviation: Transplant Proc Subsets: MEDLINE

Publication: New York, N.Y. : Elsevier Science Inc.
Original Publication: New York Stratton.

Coinfection*; Carcinoma, Hepatocellular/*surgery ; Hepatitis B, Chronic/*complications ; Hepatitis C, Chronic/*complications ; Hepatitis, Autoimmune/*immunology ; Immunoglobulin G/*blood ; Liver Cirrhosis/*surgery ; Liver Neoplasms/*surgery ; Liver Transplantation/*immunology; Antiviral Agents/therapeutic use ; Azathioprine/therapeutic use ; Carcinoma, Hepatocellular/virology ; Drug Therapy, Combination ; Hepatitis B, Chronic/diagnosis ; Hepatitis B, Chronic/drug therapy ; Hepatitis C, Chronic/diagnosis ; Hepatitis C, Chronic/drug therapy ; Hepatitis, Autoimmune/blood ; Hepatitis, Autoimmune/diagnosis ; Humans ; Immunosuppressive Agents/therapeutic use ; Interferon-alpha/therapeutic use ; Liver Cirrhosis/virology ; Liver Neoplasms/virology ; Liver Transplantation/adverse effects ; Male ; Middle Aged ; Polyethylene Glycols/therapeutic use ; Prednisone/therapeutic use ; Recombinant Proteins/therapeutic use ; Recurrence ; Ribavirin/therapeutic use ; Time Factors ; Treatment Outcome

Immunoglobulin G4 (IgG4)-associated autoimmune hepatitis (AIH) was recognized as a new disease entity; however, IgG4-associated de novo AIH after the liver transplantation had not been reported yet. Herein we have described a 56-year-old man who developed IgG4 de novo AIH as 1 year-post liver transplantation after receiving pegylated interferon alpha-2a and ribavirin therapy for hepatitis C virus recurrence. The histopathologic evidence showed an aggressive lymphoplasmacytic interface hepatitis with centrilobular necrosis (plasma cells > 30%) and IgG4-positive plasma cells (>10 per high power field). Serum IgG (9220 mg/dL) and IgG4 (3289 mg/dL) were also elevated. Improvement of liver function tests (LFTs) by prednisone and azathioprine therapy are manifested as normalized alanine aminotransferase and IgG levels. IgG4 relates to more severe histological activity; however, it is believed to be a good prognostic predictor of a response to prednisone plus azathioprine therapy especially with early diagnosis and timely management.
(Copyright © 2013 Elsevier Inc. All rights reserved.)

0 (Antiviral Agents)
0 (Immunoglobulin G)
0 (Immunosuppressive Agents)
0 (Interferon-alpha)
0 (Recombinant Proteins)
3WJQ0SDW1A (Polyethylene Glycols)
49717AWG6K (Ribavirin)
MRK240IY2L (Azathioprine)
Q46947FE7K (peginterferon alfa-2a)
VB0R961HZT (Prednisone)

Date Created: 20130319 Date Completed: 20130830 Latest Revision: 20181202

20221213

10.1016/j.transproceed.2012.02.049

23498828