title: Longitudinal variation in hepatitis C virus (HCV) viraemia and early course of HCV infection after liver transplantation for HCV cirrhosis: the role of different immunosuppressive regimens.
abstract: BACKGROUND
  The role of the type of immunosuppression in the natural history of post-transplant hepatitis C virus (HCV) infection is unclear.
  
  
  OBJECTIVE
  To evaluate the fluctuation of HCV viraemia and the early course of infection, and their relation to the type of immunosuppression in HCV transplant patients.
  
  
  METHODS
  In 47 HCV transplant patients, serum HCV RNA levels were determined pretransplant and at one and two weeks, and three and 12 months after transplant. Initial immunosuppression was triple (cyclosporin, azathioprine, prednisolone) in 31, double (cyclosporin, prednisolone) in five, and single (cyclosporin or tacrolimus) in 11 patients. Prednisolone was withdrawn at a median of six months.
  
  
  RESULTS
  At three months, HCV RNA levels were higher in patients with single than with triple or double initial therapy. At 12 months, HCV RNA levels correlated only with duration of prednisolone treatment and were relatively higher in patients with triple compared with single initial immunosuppression. A higher necroinflammatory activity at 12 months post-transplant was found in patients with post-transplant acute hepatitis compared with those without. Extent of fibrosis at 12 months was associated with the 12 month HCV RNA level and occurrence of post-transplant acute hepatitis.
  
  
  CONCLUSIONS
  HCV RNA levels at three months after transplant are higher in patients treated with single initial immunosuppressive therapy, but at 12 months are higher in patients with longer duration of steroid treatment. HCV viraemia at 12 months seems to be particularly important, as its levels are strongly correlated with the severity of fibrosis.
authors.affiliation: Liver Transplantation Unit, Royal Free Hospital, London, UK.
authors.forename: G V
authors.initials: GV
authors.lastname: Papatheodoridis
authors.forename: S G
authors.initials: SG
authors.lastname: Barton
authors.forename: D
authors.initials: D
authors.lastname: Andrew
authors.forename: G
authors.initials: G
authors.lastname: Clewley
authors.forename: S
authors.initials: S
authors.lastname: Davies
authors.forename: A P
authors.initials: AP
authors.lastname: Dhillon
authors.forename: G
authors.initials: G
authors.lastname: Dusheiko
authors.forename: B
authors.initials: B
authors.lastname: Davidson
authors.forename: K
authors.initials: K
authors.lastname: Rolles
authors.forename: A K
authors.initials: AK
authors.lastname: Burroughs
mesh_terms: D000208:Acute Disease; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D016174:Hepacivirus / Q000276:immunology / Q000302:isolation & purification; D006526:Hepatitis C / Q000276:immunology; D019698:Hepatitis C, Chronic / Q000601:surgery* / Q000821:virology; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods*; D008103:Liver Cirrhosis / Q000473:pathology / Q000601:surgery* / Q000821:virology; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000276:immunology; D012367:RNA, Viral / Q000378:metabolism; D012008:Recurrence; D014766:Viremia / Q000276:immunology*
chemical_list: D012367:RNA, Viral