Hepatitis C after liver transplantation

Recurrent Hepatitis C in Liver Allografts: Early Histologic Indicators

Our purpose was to establish the earliest histologic parameters of acute hepatitis that correlated with recurrent hepatitis C virus (HCV) infection in liver allografts. Histologic reviews of posttransplant liver biopsies from eight patients with pretransplant chronic HCV (group I) and eight with pretransplant non-HCV liver disease (group II) were performed and correlated with concurrent or subsequent presence or absence of HCV-RNA by polymerase chain reaction (PCR). Six of eight group I patients developed HCV-RNA positivity in liver and serum. Of the histologic parameters studied, the presence of Kupffer cell hyperplasia, spotty hepatocellular necrosis (acidophil bodies), or both, correlated the most with the earliest diagnosis of acute recurrent hepatitis. The postoperative time period for the earliest diagnosis of recurrent HCV was variable (34 to 123 days). These early indicators and the time of their appearance were not predictive of the course of the disease process or the final outcome of the patient. The recurrence rate of HCV infection in liver allografts is high. The presence of Kupffer cell hyperplasia and diffusely scattered acidophil bodies are reliable, early histologic indicators of an acute hepatitic process.

Review of nonimmunological causes for deteriorated graft function and graft loss after transplantation

Various factors determine the graft- and patient survival after transplantation. HLA-matching and immunological factors are of importance for the short- and long-term survival. Apart from these obvious determinants, nonimmunological factors play an important role in defining the baseline organ quality as well as the recipients' status. The influence of these parameters on graft- and patient survival is still underestimated and is a topic of debate. On account of the increasing acceptance of marginal-donor organs these events are of increasing importance for graft survival and long-term function. We review nonimmunological causes for deteriorated graft function and graft loss after solid organ transplantation.

Histological features after liver transplantation in alcoholic cirrhotics

BACKGROUND/AIMS

Though alcoholic cirrhosis is a common indication for liver transplantation, it carries the risk of alcohol recidivism and consequent graft failure. This study aims to evaluate the effect of alcohol recidivism on survival rates and histological parameters in patients transplanted for alcoholic cirrhosis, with and without hepatitis C virus (HCV) infection.

METHODS

Fifty-one out of 189 consecutive transplanted patients underwent psychosocial evaluation and liver biopsy at 6 and 12 months, then yearly after transplantation.

RESULTS

The cumulative 84 month survival rate was identical in patients transplanted for alcoholic (51%) and non-alcoholic cirrhosis (52%). No difference emerged between anti-HCV negative vs. positive alcoholic cirrhosis patients. Psycho-social evaluation revealed alcohol recidivism in 11/34 long-term survivors, but this did not affect overall survival rate in patients with or without HCV. In anti-HCV negative cases, fatty changes and pericellular fibrosis were significantly more common in heavy drinkers than in occasional drinkers and abstainers. When HCV status was considered regardless of alcohol intake, fibrosis was significantly more frequent in patients with HCV.

CONCLUSION

Alcohol recidivism after transplantation in alcoholic cirrhosis patients does not affect survival, irrespective of HCV status. Fatty changes and pericellular fibrosis are the most relevant histological signs of heavy alcohol intake.

Serum hepatitis C virus RNA levels and histologic findings in liver allografts with early recurrent hepatitis C

BACKGROUND

Histopathologic features of early recurrent hepatitis C after orthotopic liver transplantation (OLTx) may be modified by immunosuppressive therapy or complicated by other conditions. Hepatitis C virus (HCV) RNA level usually increases after OLTx, but its correlation to histologic findings is not clear.

OBJECTIVE

To evaluate the histologic findings of early recurrent hepatitis C in liver allografts and its correlation to serum HCV RNA level.

METHODS

We studied 14 patients who underwent OLTx for chronic HCV infection. Thirty liver biopsy specimens and HCV RNA levels of 22 corresponding plasma samples obtained during the first 6 months following OLTx were analyzed. The control group (9 patients, 25 biopsy specimens) was chosen at random from patients with chronic liver disease other than HCV who were undergoing OLTx, and all tested negative for HCV RNA by polymerase chain reaction after OLTx.

RESULTS

Statistically significant pathological features of early recurrent HCV infection were the number of acidophilic bodies, piecemeal necrosis, lymphocyte predominance in the portal tracts, and fibrous septum. These findings and histologic activity index scores increased with time after OLTx. The HCV RNA levels determined by branched DNA assay showed no significant correlation with histologic features. However, patients with higher histologic activity index scores tended to have higher RNA levels.

CONCLUSIONS

Liver biopsy specimens are helpful for the diagnosis or confirmation of early recurrent hepatitis C in liver allografts, but serial biopsy specimens are sometimes required for definite diagnosis. The HCV RNA levels are usually higher in patients who display signs of more severe liver damage.

Recurrent hepatitis C after liver transplantation

Cirrhosis due to hepatitis C is now the commonest indication for liver transplantation in Western Europe and in the United States. Graft reinfection is almost universal. The natural history of recurrent hepatitis C ranges from minimal damage to cirrhosis in a few months or years. Different virus and host immune factors are involved in the pathogenesis of hepatitis and are determinants of the outcome. The association between immunosuppression and severity of HCV recurrence is conflicting and remains to be evaluated fully. The treatment of recurrent HCV disease with IFN or ribavirin, as monotherapy, is ineffective. Preliminary results from combination therapy, however, are encouraging. Currently, a reasonable approach would be to treat patients with histological and clinical disease progression. New approaches for the prophylaxis of recurrent hepatitis C are under evaluation but whether this treatment will influence the severity of liver disease or the outcome of recurrence is still unknown.

High prevalence of hepatitis G virus after liver transplantation without apparent influence on long-term graft function

BACKGROUND/AIMS

Hepatitis G virus is a recently characterized transfusion-transmissible RNA virus. Its pathogenicity remains to be established. We studied its prevalence in liver transplant patients and assessed the long-term influence on the liver graft.

METHODS

Thirty-nine adult patients without hepatitis B or C were included; median follow-up was 8 years (range 1-17). Serum samples from before and late after transplantation were investigated for the presence of HGV-RNA. HGV-RNA was detected by cDNA-PCR, using primers from the NS3 region of the viral genome. The latest available yearly liver biopsy was assessed in a coded fashion according to established histological criteria. The outcome in the HGV-positive patients was compared with the outcome in the HGV-negative patients with respect to liver tests and liver histology.

RESULTS

The prevalence before and after transplantation was 15.4 and 43.6%, respectively. Liver test results and liver histology did not differ between the HGV and non-HGV groups. In both groups more than 50% of the patients showed normal histology. Mild portal and/or lobular inflammation tended to be more prevalent in the non-HGV group (no statistical difference).

CONCLUSIONS

HGV infection is highly prevalent in liver transplant patients. In the absence of co-infection with hepatitis B or C virus, no long-term negative influence on the graft occurs.