Biochemical and Histologic Evaluation of Recurrent Hepatitis C Following Orthotopic Liver Transplantation

Shiffman, M.L.; Mj, Contos; Va, Luketic; Aj, Sanyal; Pp, Purdum; As, Mills; Fisher, Rosemary A.; Mp, Posner

doi:10.1097/00007890-199402000-00009

Cited by 71 publications

(26 citation statements)

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“…The very few 1 year and beyond samples examined here did not provide convincing evidence of recurrent hepatitis C histologically. This is similar to prior studies that demonstrated morphologic evidence of recurrent hepatitis C in only 50 to 70% of cases (5,12,21,23). Although this study was not designed to trace the FIGURE 6.…”

Section: Discussionsupporting

confidence: 91%

“…Although orthotopic liver transplantation has emerged as an effective treatment for end stage chronic hepatitis C, recurrent infection of the allograft occurs almost universally according to most authors (1,2,4,5,12,(15)(16)(17)(18)(19)(20)(21)(22)(23). The major supporting evidence has been the post-OLT persistence of HCV RNA in serum, detected using the PCR technique, in nearly all cases (3,4,18,19,24).…”

mentioning

confidence: 99%

“…Despite the nearly universal recurrence of HCV viremia post-OLT, the frequency with which recurrent hepatitis is recognized histologically is only in approximately 50 to 70% of cases (5,12,21,23), with differences possibly reflecting varying thresh-olds for diagnosis and follow-up intervals. Recurrent hepatitis C seems to begin as a lobular hepatitis that is typically recognized several months post-OLT (5,12) and evolves to a chronic, portaldominant hepatitis over the next several months.…”

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confidence: 99%

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Early Detection of Hepatitis C Allograft Reinfection after Orthotopic Liver Transplantation: A Molecular and Histologic Study

et al. 2000

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After orthotopic liver transplantation (OLT), patients with chronic hepatitis C virus (HCV) infectionshow nearly universal persistence of viremia and reinfection of the liver, but identifying the point at which the liver is reinfected morphologically can be difficult. One tool that may potentially be useful to detect reinfection is reverse transcriptasepolymerase chain reaction (RT-PCR), which has proven to be highly sensitive for detecting HCV RNA in formalin-fixed paraffin-embedded liver tissue. Our purpose was to gain insight into the time frame of HCV reinfection by assaying for HCV RNA in serial posttransplant liver biopsy specimens. Our study population consisted of 14 patients who underwent liver transplantation for hepatitis C and had confirmed HCV RNA in pretransplant serum, absence of HCV RNA in donor livers, and available consecutive posttransplant liver allograft specimens. We performed RT-PCR for HCV RNA in serial posttransplant liver biopsy specimens, beginning at 1 week until at least one biopsy from each tested positive. HCV RNA was detected in liver tissue by RT-PCR in 1-week post-OLT liver samples in 6 of 14 (42.8%) patients, the earliest being 5 days post-OLT. Eventually, each of the remaining eight samples became RT-PCR positive as well; the first detections occurred in these at 3 weeks (three cases), 4 weeks (three cases), 48 weeks (one case), and 144 weeks (one case). Histologic identification of hepatitis C recurrence was relatively insensitive in relation to these molecular data. These data suggest that (1) HCV RNA reinfection is nearly universal after liver transplantation in patients with chronic hepatitis C infection, (2) molecular reinfection by HCV occurs at a variable interval post-OLT, with the majority of allograft livers reinfected as early as 1 week, and (3) morphologic features of hepatitis C are usually appreciable at the time of "molecular" recurrence.

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Section: Discussionsupporting

confidence: 91%

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confidence: 99%

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confidence: 99%

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Early Detection of Hepatitis C Allograft Reinfection after Orthotopic Liver Transplantation: A Molecular and Histologic Study

et al. 2000

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“…3 Despite the high recurrence rate, HCV infection leads to graft disease in a variable proportion of patients (14%-80%). [4][5][6][7][8] The degree of clinical and histological liver dysfunction also varies widely among patients with recurrent hepatitis C, ranging from mild hepatitis to a rapidly progressive cholestatic syndrome leading to graft failure and death. The factors that determine the clinical outcome in these patients are not clear and probably involve viral and host factors and immunosuppressive regimens.…”

Section: Prevalence and Consequences Of Recurrent Hcv Infectionmentioning

confidence: 99%

Do viral genotypes and HLA matching influence the outcome of recurrent hepatitis C virus infection after liver transplantation?

González‐Peralta

Lau

1998

Liver Transpl

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“…Early reports suggested the lobular hepatitis that occurred in the majority of recipients was selflimited and most patients had a benign postoperative course. [5][6][7] More recent reports indicate that although graft and patient survival rates are similar to those of patients who underwent transplantation for other indications, HCV can cause severe graft damage post-OLT. [8][9][10] Actuarial survival is decreased in patients with posttransplantation hepatitis.…”

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confidence: 99%

Prediction of liver allograft fibrosis after transplantation for hepatitis C virus: Persistent elevation of serum transaminase levels versus necroinflammatory activity

et al. 2000

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Recurrence of hepatitis C virus (HCV) after orthotopic liver transplantation (OLT) remains a significant source of morbidity and mortality. Factors that reliably predict allograft injury from HCV have not been identified. Demographics, clinical data, and histopathological characteristics of recipients with and without persistently elevated serum transaminase levels (PEST) were compared. Twenty-four patients with HCVinduced end-stage liver disease who underwent OLT between October 1995 and December 1998 were entered into a longitudinal, prospective evaluation for identification of parameters associated with graft injury. Liver biopsies were performed preoperatively and between posttransplantation days 1 to 28, 29 to 60, 61 to 180, 181 to 360, and then every 6 to 12 months thereafter. Biopsy specimens were reviewed in a blinded fashion and scored for rejection, necroinflammatory activity, extent of fibrosis, and infiltrating cell type, location, and magnitude. Transplant recipients with PEST (alanine transaminase level G1.5 times normal for 3 consecutive months) and cholestatic hepatitis showed an increased viral load compared with their own preoperative values (16-fold and 256-fold, respectively). Compared with control transplant recipients, PEST was associated with macrovesicular steatosis within 28 days after OLT (P F .05) and showed an increased rate of fibrosis (P F .003) despite similar degrees of rejection and necroinflammatory activity. There was no difference in demographics or immunosuppression. Macrovesicular steatosis may be the earliest predictor of graft fibrosis. Despite similar degrees of necroinflammatory activity, transplant recipients with PEST had an increased rate of fibrosis that could be predicted on average within 6 months posttransplantation.

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Biochemical and Histologic Evaluation of Recurrent Hepatitis C Following Orthotopic Liver Transplantation

Cited by 71 publications

References 0 publications

Early Detection of Hepatitis C Allograft Reinfection after Orthotopic Liver Transplantation: A Molecular and Histologic Study

Early Detection of Hepatitis C Allograft Reinfection after Orthotopic Liver Transplantation: A Molecular and Histologic Study

Do viral genotypes and HLA matching influence the outcome of recurrent hepatitis C virus infection after liver transplantation?

Prediction of liver allograft fibrosis after transplantation for hepatitis C virus: Persistent elevation of serum transaminase levels versus necroinflammatory activity

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