Histological and clinical outcome after liver transplantation for hepatitis C

Abstract

Hepatitis frequently recurs after liver transplantation for hepatitis C. However, the histological progression of disease, predictors of recurrence and disease severity, and patient survival remain uncertain. Fifty-five patients with cirrhosis caused by chronic hepatitis C underwent liver transplantation between January 1990 and December 1993. Hepatitis C genotype was determined, and liver biopsies were performed at frequent intervals posttransplantation. The median follow-up time was 40.4 months. The cumulative rate of survival was no different in liver transplant recipients for hepatitis C than in liver transplant recipients for other chronic liver diseases (P = .62). Histological recurrent hepatitis C developed in 33 of 50 patients assessable for disease recurrence; the median recurrence-free survival time was 13.4 months. Histological activity and stage were mild in most cases. Only 2 patients developed cirrhosis, and no patient required a second transplantation for recurrent disease. Patients with acute cellular rejection had a shorter recurrence-free survival (P = .0141). In patients with recurrent hepatitis, rejection also was correlated with increased histological grade 2 years after transplantation (P = .0061). Recurrence-free survival was decreased in patients infected with genotype 1 (1a and 1b combined) compared with genotypes 2 and 3 combined (P = .02), whereas there was no difference between genotypes 1a and 1b (P > .80). Only patients infected with genotype 1a or 1b developed bridging fibrosis or cirrhosis. In addition, patients who had an early recurrence had a greater risk of progressing to bridging fibrosis or cirrhosis (hazard ratio, 5.1; P = .0473). In our experience, recurrent hepatitiS C after liver transplantation in most cases is mild and survival is unaffected. Both acute cellular rejection and infection with genotype 1 are independent risk factors for reduced recurrence-free survival, and early recurrence is associated with a higher risk of disease progression.

The Influence of Viral Genotypes and Rejection Episodes on the Recurrence of Hepatitis C After Liver Transplantation

“…On the other hand, recent reports demonstrated no difference in the patients' survival between OLT for hepatitis C and those for other liver diseases. 1,4 Our findings are also consistent with these previous studies. Unfortunately, HCV RNA by polymerase chain reaction was not available in every case because of the retrospective nature of the study; however, 93% were HCV RNApositive at the end of follow-up.…”

“…[1][2][3] Recently published studies showed no difference in the survival between patients with hepatitis C and those receiving liver transplants for other conditions, even though a reinfection by HCV in the recipients is nearly universal. 1,4 However, in some patients HCV reinfection induces a progressive disease which may lead to graft failure or graft cirrhosis, and the need for retransplantation. [5][6][7] The reason why some patients develop recurrent hepatitis very early after transplant while others progress slowly over several months is still unclear.…”

Genotype Distribution And 5' Utr Nucleotide Changes In Hepatitis C Virus

“…Hepatit C Virüsü, Hepacivirüsler genusunda Flaviviridae ailesinde yaklaşık 40-50 nm çapında, dışta lipid zarf taşıyan bir virüstür (3,4). HCV'nin genomu tek zincirli pozitif sens bir RNA molekülüdür.…”

“…ORF genomun büyük bir kısmını kapsamaktadır ve yaklaşık 3010 aminoasit uzunluğunda bir poliproteini kodlar. HCV genomunun her iki ucunda (5' ve 3') ise ürüne dönüşmeyen (untranslated region, 5'UTR, 3'UTR) bölgeler bulunmaktadır (3,5).…”

“…Bunun biyolojik etkileri, konak savunmasından kaçan mutasyonların oluşması, hücre tropizminde ve virulansta değişiklik ve antiviral ajanlara direnç şeklinde olabilir. Virus-konak ilişkilerinde etkili olabilecek genotipler ve mutasyonlar hakkında daha detaylı bilgilerin elde edilebilmesi için ileri moleküler ve klinik çalışmalara ihtiyaç bulunmaktadır (3).…”