I have a patient, post living donor kidney transplantation who was to be posted for liver transplant following hepatitis c associated decompensation but spontaneously cleared the hep c infection with improved liver functions and deferred liver transplant.
Spontaneous clearances are truly rare events in the setting of and organ transplantation. It is thought that 100% of HCV cases will be recurrent post transplant of liver and/or kidney transplant. As you know the course can be quite variable from minimal effects on graft to loss within one year from the dreaded fibrosing cholestatic presentation. We have seen a few "spontaneous" clearances in the setting of changes of immunosupression. In attempts to allow for better host defenses the prograf doses were lowered. When the prograf was at .5 mg every other day, one patient flared with hepatitis never to have a return of measurable HCV. Interestingly she had a large jump in the immune cell function assay from very low i.e. 20 to 300 at the same time she cleared.
It can happen sometimes after liver transplantation. This demonstrates that hepatocytes show a genetic dependant response to the the virus. But it is not clear if this spontaneous clearence is associated with kidney transplantation. However, interestingly, the previous decompensation might be the cause of the clearence. The damage to the liver caused by HCV is essentially due to an inflammatory response to the virus by our immune system. In a chronic HCV infected patient , this response changes during a timeline, sometimes is very strong and acute, sometimes just stable. Maybe (and just maybe) the decompensation was caused by a very strong immune reaction to the virus, which caused the decompensation and the clearence at the same time, and then it ended spontaneously.
As above these are rare events, i have seen them following decompensation - in particular with alcoholic hepatitis. Also worth mentioning that there are case reports of spontaneous clearance at the time of development of HCC.
I saw a case of spontaneous clearance of HCV after liver transplantation on a patient that also needed dialysis (dialysis is known to lower viral load).
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