Predictors of Disease Recurrence Post Living Donor Liver Transplantation in End Stage Chronic HCV Patients

Abstract

HCV recurrence represents a universal phenomenon after liver transplantation. In this study Fifty HCV patients who underwent living donor liver transplantation were enrolled and factors that may accelerate HCV reinfection of the allograft such as donor's age and degree of liver steatosis, recipient's age, gender, BMI, MELD score, liver functions, HCV viral load, type of immunosuppressive drug, and genetic polymorphisms of IL28B, OAS, and IL1B were studied. The results of disease-free survival (DFS) rates showed inverse correlation with the recipient's postoperative levels of ALT, AST, ALP (P < 0.001, <0.001, and 0.006 resp.) as well as pre- and postoperative titers of HCV RNA (P < 0.003 and <0.001 resp.). Recipient's IL28B SNP was a significant factor in predicting postoperative DFS (P < 0.025). However, SNPs in OAS and IL1B genes had no apparent correlation with DFS. Cox proportional hazards model revealed that patients with elevated levels of ALT, preoperative viral titers, IL28B CT, and IL28B TT were 8.28, 4.22, 3.35, and 1.36 times, respectively, more likely to develop recurrence. In conclusion IL28B SNP, ALT level, and preoperative HCV titer besides proper choice of immunosuppressant are helpful for predicting posttransplant HCV recurrence and DFS.

Evaluation of seven gene signature for predicting HCV recurrence post-liver transplantation

“…Our data shed light that HCV viral load post-transplant is significantly affecting HCV recurrence. Supportive studies affirmed that advanced donor age and/or high HCV viral loads post-transplant corresponded with aggressive HCV recurrence and allograft loss in HCV-positive liver transplant recipients [12,37]. Cyclosporine (as a calcineurin inhibitor (CNI))-based regimen is the main immuno-suppression protocol followed in this study.…”

“…Liver function tests were repetitively delineated to affect HCV recurrence after OLT [10,12]. Definitely, our data showed that the increased risk of the HCV recurrence was correlated with augmented ALT, AST, and ALP levels.…”

“…Fernández-Rodríguez et al reported that the diagnostic value of the CRS to deduce the liver fibrosis deterioration is limited in HIV/HCV coinfected patients [35]. Other well-known genetic variations as IL1B and IL28B evinced a statistically significant correlation with the poor outcome post-transplantation [12].…”

“…Around 81% (39) patients have non-Rec were LS, while 61% (19) patients suffered HCV Rec were HS. On the other hand, 39% (12) patients have HCV Rec were LS, while 19% (9) patients have HCV Rec were HS (p<0.001; see Table 7).…”

“…Recurrent HCV-associated liver disease leads to a consequent loss of graft in about one third of patients within 5 years of OLT and recurrent HCV-associated graft failure is the main cause of patient mortality and re-transplantation in the 5th postoperative year [10]. Several factors are crucial to minimize the complications and improve the clinical outcome such as choice of a suitable donor, appropriate immunosuppressive treatment, and genetic risk stratification prior to transplantation [11,12].…”