Touching stories of living donor transplantation are continuously happening in hospitals. One of these stories is reported recently in the August 14 issue of the World Journal of Gastroenterology because of its shining significance in hepatology. This article is going to bring comfort to many families.
It is about a desperate patient brought to Dr. Tatsuki Ichikawa in the Nagasaki University Hospital, Japan in 2004. This patient was quite a challenge for Dr Ichikawa. She was 60 years old with liver cirrhosis (LC) and liver cancer caused by hepatitis C virus (HCV); she had been diagnosed diabetic since 1995; and previous chemotherapies aiming to remove cancer did not bring any satisfactory result.
To free the patient from the severely damaged liver, liver transplantation (LT) was considered by Dr. Ichikawa when a loving daughter of the patient decided to donate part of her liver to her mother. However, one possibility that concerned Dr. Ichikawa most was that the explanted liver would get re-infected and progress rapidly to LC, since previous data indicated that complete clearance of HCV is the prerequisite for patients to have a good outcome. To minimize this possibility, patients were traditionally treated with interferon (IFN) and/or ribavirin before LT.
Trying to save the life of the patient, Dr Ichikawa decided to introduce the more powerful medicine, PEGylated IFN, in the treatment before liver transplantation. PEGylation is a chemical modification incurring higher water-solubility and higher stability to the modified polypeptide medicine. Five weeks after the PEG-IFN treatment, HCV antigen was no longer detectable from the patient serum, but HCV-RNA persisted. Even after the long treatment for 18 weeks, HCV RNA was still detectable. Since the complete clearance of HCV RNA seemed impossible, the liver transplantation was performed.
Unexpectedly and excitingly, clearance of HCV RNA was achieved just one month after the successful liver transplantation and HCV was never detected in this patient thereafter. Thus, this is the first reported case in which a complete recovery from HCV infection was achieved after LT, with a patient who was diagnosed positive in HCV-RNA and negative in HCV core antigen before LT. Dr. Ichikawa suggested that the long acting of PEG-IFN might bring good outcome to similar patients awaiting liver transplantation.
This case no doubt brings promising future for many LC patients. Due to the high percentage of HCV infected population in the world and unavailability of commercial vaccine against HCV, the case reported by Dr Ichikawa surely worth the attention of both doctors and common people.
Reference: World J Gastroenterol 2007, August 14; 13(30): 4149-4151 http://www.wjgnet.com/1007-9327/13/4149.asp
Correspondence to: Tatsuki Ichikawa, M.D., The First Department of Internal Medicine, Graduate School of Biomedical Science, Nagasaki University, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan. firstname.lastname@example.org Telephone: +81-95-8497260 Fax: +81-95-8497270
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World Journal of Gastroenterology (WJG), a leading international journal in gastroenterology and hepatology, has established a reputation for publishing first class research on esophageal cancer, gastric cancer, liver cancer, viral hepatitis, colorectal cancer, and H pylori infection for providing a forum for both clinicians and scientists. WJG has been indexed and abstracted in Current Contents/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch) and Journal Citation Reports/Science Edition, Index Medicus, MEDLINE and PubMed, Chemical Abstracts, EMBASE/Excerpta Medica, Abstracts Journals, Nature Clinical Practice Gastroenterology and Hepatology, CAB Abstracts and Global Health. ISI JCR 2003-2000 IF: 3.318, 2.532, 1.445 and 0.993. WJG is a weekly journal published by WJG Press. The publication date is 7th, 14th, 21st, and 28th day of every month. The WJG is supported by The National Natural Science Foundation of China, No. 30224801 and No.30424812, and was founded with a name of China National Journal of New Gastroenterology on October 1, 1995, and renamed as WJG on January 25, 1998.
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World Journal of Gastroenterology