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Long-term outcome of hepatitis C infection after liver transplantation
E J Gane1, B C Portmann, N V Naoumov
1Institute of Liver Studies, Kings's College School of Medicine and Dentistry, London, United Kingdom.
Insights
Persistent hepatitis C virus (HCV) infection after liver transplant can cause severe graft damage, especially with genotype 1b. However, patient and graft survival rates are similar between HCV-infected and non-infected recipients five years post-transplant.
Area of Science:
- Hepatology
- Transplantation Immunology
- Virology
Background:
- Hepatitis C virus (HCV) infection is a leading cause of end-stage liver disease and liver transplantation.
- Viremia often persists post-transplant, necessitating investigation into its impact on outcomes.
- Understanding factors influencing recurrent hepatitis severity is crucial for improving post-transplant care.
Purpose of the Study:
- To assess the impact of persistent HCV infection on patient and graft survival after liver transplantation.
- To evaluate the influence of HCV genotype and HLA matching on the severity of recurrent hepatitis.
- To compare outcomes in HCV-infected recipients versus a control group of HCV-negative recipients.
Main Methods:
- A cohort of 149 HCV-infected liver transplant recipients was followed for a median of 36 months.
- A control group of 623 HCV-negative liver transplant recipients was included for comparison.
- Liver biopsy specimens from recipients were reviewed to assess the severity of recurrent hepatitis.
Main Results:
- Five-year survival rates were similar between HCV-infected (70%) and HCV-negative (69%) recipients (P=0.12).
- Among HCV-infected recipients, 12% had no chronic hepatitis, 54% mild, 27% moderate, and 8% cirrhosis.
- HCV genotype 1b was associated with more severe graft injury, while HLA matching and immunosuppression had no significant effect.
Conclusions:
- Persistent HCV infection post-liver transplantation can lead to significant graft damage, particularly with genotype 1b.
- Despite potential for graft damage, overall and graft survival rates are comparable between HCV-infected and non-infected recipients at five years.
- HCV genotype is a key determinant of recurrent hepatitis severity, influencing graft outcomes.
Background:
End-stage cirrhosis related to hepatitic C virus (HCV) is a common reason for liver transplantation, although viremia ia known to persist in most cases. We investigated the impact of persistent HCV infection after liver transplantation on patient and graft survival and the effects of the HCV genotype and the degree of HLA matching between donor and recipient on the severity of recurrent hepatitis.
Methods:
A group of 149 patients with HCV infection who received liver transplants between January 1982 and April 1994 were followed for a median of 36 months; 623 patients without HCV infection who underwent liver transplantation for end-stage chronic liver disease were used as a control group. A total of 528 liver-biopsy specimens from the HCV-infected recipients were reviewed, including 82 obtained one year after transplantation as scheduled and 39 obtained at five years as scheduled. In addition, biopsy specimens were obtained from 91 of the HCV-negative patients five years after transplantation.
Results:
Cumulative survival rates for the 149 patients with HCV infection were 79 percent after one year, 74 percent after three years, and 70 percent after five years, as compared with rates of 75 percent, 71 percent, and 69 percent, respectively, in the HCV-negative transplant recipients (P=0.12). Of the 130 patients with hepatitis C infection who survived more than 6 months after transplantation, 15 (12 percent) had no evidence of chronic hepatitis on their most recent liver biopsy (median followup, 20 months), 70 (54 percent) had mild chronic hepatitis (median, 35 months), 35 (27 percent) had moderate chronic hepatitis (median, 35 months), and 10 (8 percent) had cirrhosis (median, 51 months). Graft loss occurred after a median of 303 days in 27 of the 149 patients, including 5 with HCV-related cirrhosis and 3 with HCV-related cholestatic hepatitis. Infection with HCV genotype 1b was associated with more severe graft injury, whereas the primary immunosuppressive regimen used and the extent of HLA mismatching between donors and recipients had no significant effect on this variable.
Conclusions:
After liver transplantation for HCV-related cirrhosis, persistent HCV infection can cause severe graft damage, and such damage is more frequent in patients infected with HCV genotype 1b than with other genotypes. After five years, the rates of graft and overall survival are similar between patients with and those without HCV infection.