Direct acting antivirals (DAAs) for hepatitis C virus (HCV) have been widely prescribed to post-liver transplant patients for HCV clearance and are believed to be superior to interferon treatment due to fewer adverse side effects. We report the first suspected cases of de novo autoimmune hepatitis (AIH) in patients cleared of HCV with DAA treatment after liver transplant. We identified seven patients treated with DAAs who had persistent transaminase elevation. Liver biopsy confirmed findings of de novo autoimmune hepatitis in at least two patients, including marked portal inflammation with grade 2 interface hepatitis (Figure 1), and expansion of periportal tracts and lobular inflammation consisting primarily of plasma cells, lymphocytes, and eosinophils (Figure 2, arrow denotes plasma cell). Both patients underwent liver transplant for HCV cirrhosis and hepatocellular carcinoma. Patient #1 was treated with 12 weeks of sofosbuvir and simeprevir and Patient #2 was treated with 6 months of sofosbuvir and ribavirin. Both patients achieved sustained virologic response and subsequently developed worsening transaminases, which improved with a course of steroids once they were diagnosed with AIH. DAAs are known to be effective treatments for the clearance of HCV, though special attention should be given to post-transplant patients who fail to normalize their transaminases post HCV clearance as these patients may be at risk for de novo AIH.

CITATION INFORMATION: Sigireddi R, Moffett J, Kueht M, Ackah R, Rana A, O'Mahony C, Goss J, Dhingra S, Khaderi S. An Investigation of Biopsy-Proven De Novo Autoimmune Hepatitis After Hepatitis C Clearance with Direct Acting Antivirals in Liver Transplant Patients. Am J Transplant. 2017;17 (suppl 3).

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