Related Experiment Videos
Hepatitis C and liver transplantation
1Hopital Saint-Antoine, Paris, France.
Insights
Hepatitis C virus (HCV) recurrence after liver transplant is common, affecting many recipients. While short-term survival is good, HCV negatively impacts long-term patient and graft survival, necessitating further study.
Area of Science:
- Hepatology
- Transplantation Immunology
- Virology
Background:
- Chronic Hepatitis C virus (HCV) infection is a leading cause of end-stage liver disease and liver transplantation in North America and Europe.
- HCV recurrence post-liver transplant is nearly universal, leading to viremia in many recipients, impacting graft and patient survival.
- HCV can be acquired during transplantation through infected donors or transfused blood, posing a significant challenge in immunosuppressed patients.
Purpose of the Study:
- To highlight the significance of Hepatitis C virus (HCV) in liver transplant recipients.
- To discuss the implications of HCV recurrence on post-transplant outcomes.
- To evaluate the impact of HCV infection on patient and graft survival rates.
Main Methods:
- Review of existing literature on HCV in liver transplant recipients.
- Analysis of histological findings in allografts, identifying HCV as a primary cause of hepatitis.
- Utilizing HCV-RNA assays (e.g., b-DNA) to quantify viral load and assess recurrence.
- Comparison of patient and graft survival rates between HCV-infected recipients and control groups.
Main Results:
- HCV infection is a frequent cause of histological hepatitis in liver allografts (14-35%).
- HCV recurrence post-transplant is observed in almost all pre-transplant infected patients, often underestimated by serological assays.
- While short-term survival is comparable to non-viral liver disease, a recent study indicates HCV negatively impacts long-term patient and graft survival (P=0.001).
Conclusions:
- Hepatitis C virus poses significant challenges in liver transplantation due to high recurrence rates and negative impact on long-term outcomes.
- The magnitude of HCV infection in immunosuppressed recipients may be underestimated, with potential for a carrier state.
- Despite negative impacts, short-term survival rates support continued transplantation for HCV-infected patients, though long-term consequences require further definition.
Abstract:
Hepatitis C virus (HCV) is important to the liver transplant recipient for several reasons. First, chronic HCV infection is a frequent cause of end-stage liver disease in North America and Europe, where the majority of liver transplants are performed. Second, recurrence of HCV after liver transplantation is almost universal so that many liver transplant recipients with and without overt hepatitis are viraemic. Third, HCV infection in the organ donor and/or in the blood transfused in the peri-transplant period make acquisition of HCV possible. Finally, liver transplantation for chronic HCV infection represents a major financial burden to the health-care system in the USA and worldwide. Histological hepatitis not due to HBV or cytomegalovirus (CMV) is present in 14-35% of allografts from patients undergoing liver transplantation, and the majority of this is due to HCV infection. HCV infection recurs post-transplant in almost all patients with pre-transplant infection. Proof that HCV does recur has been provided by the sequencing of the hypervariable domain of the E2/NS1 region. The magnitude of HCV infection is underestimated by using serological assays in this immunosuppressed population. Using the b-DNA assay, HCV-RNA levels have been shown to increase in patients with recurrent infection. The long-term consequences remain to be defined but post-transplantation HCV infection is generally much less devastating than post-transplantation HBV infection, and many patients have clinically silent disease. It is likely that a carrier state exists in immunosuppressed transplant recipients since high HCV-RNA levels occur in the absence of liver damage. In one study, 1, 2 and 3 year patient survival rates were shown to be comparable in patients with chronic active HCV infection and with cryptogenic cirrhosis (94, 89 and 87%, and 84, 84 and 73%, respectively). A more recent study from the University of Pittsburgh which compared the outcome of a larger number of HCV-infected patients (n = 237) with a large number of control patients with non-viral disease (n = 801), showed that indeed HCV infection does impact negatively on both patient and graft survival (1, 2 and 3 year patient survival in the study and control groups of 78, 68 and 66% and 84, 82 and 78%, respectively, P = 0.001). Undoubtedly with time, the full impact of recurrent HCV infection will become apparent, although short-term survival is sufficiently good to warrant continued transplantation of this group of patients.(ABSTRACT TRUNCATED AT 400 WORDS)