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Objective. The objective of this study was to assess the clinical and histological course of liver transplant recipients with hepatitis C virus (HCV) prior to transplantation and of those who acquire HCV after the procedure, correlating the findings with the presence of the infectious HCV genotype.
Patients and method. A group of 26 patients, who underwent 29 orthotopic liver transplant (OLT) procedures, was stu died out of a series of 32 patients who underwent 150 OLT. Twenty-two of the patients presented HCV infection prior to OLT and 4 patients acquired the virus postoperatively. The serological diagnosis was based on the detection of anti-HCV antibodies by ELISA-3 and confirmed by RIBA-III. In addition, viral RNA was examined by polymerase chain reaction and the virus genotype was determined by the InnoLipa probe. The histological study of virus recurrence, based on liver biopsies, identified cases of acute hepatitis, chronic hepatitis (persistent or acute) and liver cirrhosis.
Results. Anti-HCV antibodies remained detectable after OLT in all 26 patients. HCV RNA was analyzed in 16 of the 18 patients studied and was found to be positive in every case. Two patients presented infection with genotype 1a, 6 with 1b, 6 with 3a, 1 with 4a and 1 with 5a. Histological evidence of recurrence in 60% of the patients, 75% of whom presented chronic persistent hepatitis, while chronic active hepatitis was detected in 25%. Four of the 110 patients (3.6%) who had been seronegative prior to OLT acquired de novo HCV post-operatively. The actuarial survival of the patients at one year was 72.5% and 67.6% at 5 years and the actuarial graft survival was 67.3% at one year and 52.3% at 5 years.
Conclusions. We consider OLT to be indicated in patients with end-stage liver disease due to HCV, despite the high rate of recurrence of infection in the liver graft, since the rates of patient and graft survival are similar to the overall survivals recorded for patients undergoing OLT for other reasons.
Patients and method. A group of 26 patients, who underwent 29 orthotopic liver transplant (OLT) procedures, was stu died out of a series of 32 patients who underwent 150 OLT. Twenty-two of the patients presented HCV infection prior to OLT and 4 patients acquired the virus postoperatively. The serological diagnosis was based on the detection of anti-HCV antibodies by ELISA-3 and confirmed by RIBA-III. In addition, viral RNA was examined by polymerase chain reaction and the virus genotype was determined by the InnoLipa probe. The histological study of virus recurrence, based on liver biopsies, identified cases of acute hepatitis, chronic hepatitis (persistent or acute) and liver cirrhosis.
Results. Anti-HCV antibodies remained detectable after OLT in all 26 patients. HCV RNA was analyzed in 16 of the 18 patients studied and was found to be positive in every case. Two patients presented infection with genotype 1a, 6 with 1b, 6 with 3a, 1 with 4a and 1 with 5a. Histological evidence of recurrence in 60% of the patients, 75% of whom presented chronic persistent hepatitis, while chronic active hepatitis was detected in 25%. Four of the 110 patients (3.6%) who had been seronegative prior to OLT acquired de novo HCV post-operatively. The actuarial survival of the patients at one year was 72.5% and 67.6% at 5 years and the actuarial graft survival was 67.3% at one year and 52.3% at 5 years.
Conclusions. We consider OLT to be indicated in patients with end-stage liver disease due to HCV, despite the high rate of recurrence of infection in the liver graft, since the rates of patient and graft survival are similar to the overall survivals recorded for patients undergoing OLT for other reasons.
Keywords:
Liver
Transplantation
Hepatitis virus C
Histology
Interferon
Retransplantation