Hepatitis C in liver transplantation: preliminary study of prognostic factors

Challenges and Controversies in the Management of Hepatitis C Virus Infection (Part 2)

Patients with HCV-related cirrhosis are frequently seen in clinical practice when the diagnosis is established either clini-cally when signs of chronic liver disease are evident, or histo-logically when liver biopsy is performed as part of the assess-ment of patients with HCV infection. It continues to be debat-able whether cirrhotic patients should receive antiviral therapy. Those who propose treatment state that eradication of HCV is the main goal of antiviral therapy thus limiting the spread of HCV infection and stress that cirrhosis is not a permanent in-jury that cannot be reversed. Opponents of antiviral therapy in patients with cirrhosis state that such treatment produces very low virological response rates in the face of a reportedly high incidence of side effects.

Living donor liver transplantation in patients with hepatitis C

1. Hepatitis C virus (HCV) is the most common indication for living donor liver transplantation (LDLT). 2. Preliminary evidence suggests that HCV may occur earlier and may be more severe in LDLT recipients. However, current data is inconclusive relative to the impact of recurrent HCV on patient and graft survival in LDLT recipients. 3. Potential mechanisms for differences in severity of HCV in LDLT recipients are discussed. 4. LDLT remains a viable treatment option for selected patients with HCV.

Hepatitis C virus genotypes and reinfection of the graft during long-term follow-up in 35 liver transplant recipients

To understand the clinical outcome of hepatitis C virus (HCV) recurrence, data from 35 liver transplant recipients who survived more than 6 months were reviewed. The presence of HCV-RNA was evaluated and genotyping was performed. On the basis of alanine aminotransferase (ALT) levels, patients were sorted into four groups. In 20 patients, a chronic elevation in ALT was found; HCV-RNA detection was positive in 17/17 and the following genotypes were found in 15 of them: 1b in ten patients, 2a in four patients, and 3a in one patient. In 11 patients, ALT levels remained normal throughout follow-up; in nine of them HCV-RNA was positive; HCV genotyping was available in eight patients and identified type 1b in two, type 2a in five, and type 3a in another patient. In two patients, ALT fluctuated above and below the upper limits of normality; type 1b HCV-RNA was found in one of them. In two patients, after an initial period of normality, ALT levels showed an abrupt rise; HCV-RNA was positive and type 1b was identified in both patients. Eight patients developed HCV-related deep jaundice and three of them spontaneously recovered. Progressive hepatic injury occurred in eight patients, six with chronic ALT elevation and two showing a late ALT elevation; genotype 1b was present in seven patients while in one, genotype 3a was found; sub-acute graft failure developed in five of them, leading to death in two and retransplantation in the others; the other three patients are alive with recurrent overt cirrhosis. The 1, 3, and 5 year actuarial survivals were 89%, 79%, and 63% respectively. The 1, 3, and 5 year actuarial risks of progressive graft damage were 6%, 7%, and 15%, respectively. In conclusion, HCV reinfection causes a slow decrease in the long-term patients' survival. Persistent elevation of ALT is more frequently observed in patients with genotype 1b infection.