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

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.
Competing Interests: Dr. Pyrsopoulos is a recipient of research grants from Bayer, Beigene, Intercept, Mallinckrodt, Eisai, Novartis, Resusix, Saro, Valeant, Gilead, Genfit, Grifols, Prometheus, and Zydus. Dr. Pyrsopoulos has also served as a consultant for Bayer and Eisai. Dr. Guarrera is a recipient of research grants from and has served a consultant for Organ Recovery Systems Inc for work in Organ Preservation. The other authors have no conflict of interests related to this publication.
(© 2020 Authors.)