Reinfection of liver graft by hepatitis C virus after liver transplantation.

Féray, Cyrille; Samuel, Didier; Thiers, Valérie; Gigou, Michelle; Pichon, François; Bismuth, A; Reynès, M; Maisonneuve, P.; Bismuth, H; Bréchot, Christian

doi:10.1172/jci115723

Cited by 256 publications

(105 citation statements)

References 18 publications

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“…It is well established that detectable serum HCV ribonucleic acid, even at a high level, after LT, does not necessarily indicate the presence of histologic RHC. 2,3,13,24 As has been described for recurrent hepatitis B, 25,26 immunosuppression may alter the histological appearance of viral hepatitis after transplantation. Consequently, in posttransplant patients, especially during the first few months when immunosuppression is maximal, classic histopathologic features of hepatitis C may be absent or modified.…”

Section: Discussionmentioning

confidence: 93%

Reliability of histopathologic assessment for the differentiation of recurrent hepatitis C from acute rejection after liver transplantation

et al. 2004

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Histopathologic assessment is considered essential for the differentiation of recurrent hepatitis C (RHC) from acute cellular rejection (ACR) after liver transplantation (LT); however, there is limited information regarding its reliability. The aim of this study was to determine the interobserver and intraobserver agreement of the histopathologic diagnosis of RHC vs. ACR, and to determine the reliability of specific histopathologic features for the differentiation of RHC from ACR. Liver biopsy specimens from 105 consecutive patients transplanted for hepatitis C virus (HCV)-related liver disease were studied retrospectively. All the biopsies were performed for evaluation of abnormal liver enzymes within the 1st year after LT. The slides were blindly coded and assessed by 5 liver-transplant pathologists, practicing at 3 medical centers. The pathologists were asked to render a diagnosis, and determine the severity of the disease. Four of the pathologists were asked to determine the presence and severity of 36 histopathologic features. A total of 34 of the samples were then blindly resubmitted to each of the 4 pathologists to determine the intraobserver agreement. There was a slight agreement ( ‫؍‬ .12) among the 5 pathologists on the histopathologic diagnosis. All 5 pathologists were in agreement on the diagnosis of RHC in only 5 patients (5%) and on the diagnosis of ACR in only 2 patients (2%). The best agreement among any 4 pathologists was fair ( ‫؍‬ .20). Slight to moderate agreement occurred on the main histological features considered to be important in the diagnosis of ACR. Intraobserver agreement ranged from slight ( ‫؍‬ .19) to moderate ( ‫؍‬ .42) among 4 pathologists. In conclusion, the histopathologic differentiation of RHC from ACR after LT had relatively low interobserver and intraobserver agreement rates, and hence showed low reliability. Histopathologic assessment should be used cautiously for the differentiation of RHC from ACR post-LT. (Liver

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Section: Discussionmentioning

confidence: 93%

Reliability of histopathologic assessment for the differentiation of recurrent hepatitis C from acute rejection after liver transplantation

et al. 2004

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“…With improvements in diagnostic techniques to detect HCV, it has been observed that recurrent HCV infection after OLT is almost universal. 1,2 Feray et al 3 showed a high degree of molecular homology between pretransplantation and posttransplantation viral isolates, confirming that the same strain of HCV is responsible for recurrent viral infection. Furthermore, Chazouilleres et al 4 have shown that the levels of serum HCV RNA increased significantly after OLT, and this is probably caused by the presence of immunosuppression in the postoperative period.…”

confidence: 97%

Clinical outcome of patients infected with hepatitis C virus infection on survival after primary liver transplantation under tacrolimus

et al. 1998

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The outcome of hepatitis C virus (HCV) infection on patient and graft survival after orthotopic liver transplantation (OLT) has been controversial. An earlier experience with a higher dose of tacrolimus (H0.1 mg/kg/d intravenously and H0.2 mg/ kg/d orally) was associated with a worse clinical outcome in patients infected with HCV. The clinical outcome of 183 liver transplant recipients with end-stage liver disease (ESLD) secondary to HCV infection (HCV group) was compared with a contemporary cohort of 556 patients with HCV infection who underwent transplantation for nonviral, nonmalignant ESLD (control group). All patients were prospectively screened for anti-HCV antibodies and HCV RNA by reverse-transcriptase polymerase chain reaction. All OLT patients were receiving low-dose tacrolimus immunosuppression. Cumulative patient survival rates for the HCV group were 80% after 1 year and 75% after 3 years compared with rates of 84% and 78%, respectively, in the control group (P ‫؍‬ .452). Primary graft survival rates at the same time intervals for the HCV group and the control group were 72% and 77.5% at 1 year and 67% and 72% at 3 years, respectively (P ‫؍‬ .144). The incidence of re-transplantation (re-OLT) in the HCV group and the control group was 12.6% and 10.4%, respectively (P ‫؍‬ The recurrence of hepatitis B virus (HBV) infection among transplant recipients has been associated with decreased patient and graft survival 5 ; these results have recently improved with longterm prophylactic strategies, 6,7 and novel antiviral agents may continue to improve the outcome of these patients. By contrast, the outcome of patients who have undergone OLT for ESLD associated with HCV infection has not been well defined. Recent reports have shown that long-term graft and patient survival are similar between patients with and without HCV infection, 8-10 although these findings may change when patients are followed up for more than 5 years after OLT..We have examined, in a retrospective cohort study, the clinical outcome of HCV infection defined by the incidence of re-transplantation (re-OLT), incidence and timing of acute cellular rejection, graft and patient survival, causes of graft failure, and death among patients infected with HCV who underwent OLT for ESLD using a low-dose tacrolimus immunosuppressant.

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“…4,6,[8][9][10] Moreover the finding of HBV DNA in peripheral mononuclear blood beyond 12 months of effective HBIG prophylaxis argues in favor of a potentially indefinite risk of graft infection. [11][12][13] As a consequence, most liver transplant centers are currently administering HBIG on a life-long basis. Because HBIG use is highly expensive, an alternative strategy aiming at the discontinuation of HBIG prophylaxis during the second year of treatment would be an important cost-effective measure.…”

Section: It Is Widely Agreed That Hepatitis B Virus Immunoglobulin (Hmentioning

confidence: 99%

Hepatitis B immunoglobulin discontinuation followed by hepatitis B virus vaccination: A new strategy in the prophylaxis of hepatitis B virus recurrence after liver transplantation

et al. 2000

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It is widely agreed that hepatitis B virus immunoglobulinSeveral reports have clearly shown that liver transplantation in patients with hepatitis B virus (HBV) infection-as defined by positivity for hepatitis B surface antigen (HBsAg)-is associated with a high rate of recurrence of HBV infection after transplantation, resulting in severe graft disease in most cases and in a significant decrease in both graft and patient survival. [1][2][3][4] It is widely accepted that the risk of HBV recurrence after liver transplantation is directly proportional to the level of viral replication before transplantation, with those recipients seropositive for HBeAg and HBV DNA by hybridization technique having the highest rate of recurrence after transplantation, irrespective of the type of liver disease. 2,4 Many prophylactic strategies have been proposed to prevent HBV infection of the graft, but only long-term passive immunoprophylaxis with HBV-specific immunoglobulin (HBIG) has obtained a significant reduction in the risk of HBV graft infection and in both graft and patient mortality after liver transplantation. [4][5][6][7] The presence of serum HBV DNA before transplantation is, however, a major predictor of lack of response to this prophylactic regimen.In light of these evidences, the European Concerted Action on Viral Hepatitis (EUROHEP) recommended in 1994 to refrain from transplanting chronic HBV carriers found to be positive for either hepatitis B e antigen (HBeAg) or HBV DNA by direct hybridization. Moreover, the rest of the recipients with HBV-related disease should receive HBIG immunoprophylaxis to maintain anti-HBs levels above 100 IU/L for at least 12 months after transplantation. 6 Currently, the beneficial effect of long-term HBIG administration has become widely accepted; still no consensus has been reached regarding the optimal duration of HBIG treatment. The rate of HBV graft infection recurrence 12 months after liver transplantation seems to be much decreased but it can still undoubtedly occur. 4,6,[8][9][10] Moreover the finding of HBV DNA in peripheral mononuclear blood beyond 12 months of effective HBIG prophylaxis argues in favor of a potentially indefinite risk of graft infection. 11-13 As a consequence, most liver transplant centers are currently administering HBIG on a life-long basis. Because HBIG use is highly expensive, an alternative strategy aiming at the discontinuation of HBIG prophylaxis during the second year of treatment would be an important cost-effective measure. We present here an assessment of the efficacy of a new prophylactic strategy consisting of the discontinuation of HBIG administration followed by active immunization with HBV vaccination in patients transplanted for HBVrelated liver diseases. PATIENTS AND METHODSPatients. Between July 1990 and April 1996, 36 HBsAg-positive recipients were submitted to liver transplantation at the Hospital Abbreviations: HBV, hepatitis B virus; HBsAg, hepatitis B virus surface antigen; HBIG, hepatitis B virus immunoglobulin; HBeAg, hepatitis B vi...

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Reinfection of liver graft by hepatitis C virus after liver transplantation.

Cited by 256 publications

References 18 publications

Reliability of histopathologic assessment for the differentiation of recurrent hepatitis C from acute rejection after liver transplantation

Reliability of histopathologic assessment for the differentiation of recurrent hepatitis C from acute rejection after liver transplantation

Clinical outcome of patients infected with hepatitis C virus infection on survival after primary liver transplantation under tacrolimus

Hepatitis B immunoglobulin discontinuation followed by hepatitis B virus vaccination: A new strategy in the prophylaxis of hepatitis B virus recurrence after liver transplantation

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