Impact of the recurrence of hepatitis C virus infection after liver transplantation on the long-term viability of the graft.
BACKGROUND
The impact of hepatitis C virus (HCV) infection recurrence after orthotopic liver transplantation (OLT) on graft viability is still not accurately defined. Our study aims to evaluate the magnitude and rate of progression of HCV-induced liver damage after OLT in a single institution cohort of 122 HCV-infected recipients.


METHODS
All patients transplanted at our institution between 1988 and 1996 with positive serum HCV antibodies before OLT, minimum postoperative survival of 6 months, and without hepatitis B virus coinfection or severe non-HCV-related graft complications were retrospectively included in the study.


RESULTS
HCV infection recurrence was almost universal, and genotype 1b was observed in 87% of the cases. After a median histological follow-up of 43 months (range: 7-96), evidences of HCV-induced histological damage were found in 94% of the cases. The actuarial rates of severe graft damage (including cirrhosis, fibrosing cholestatic hepatitis, and submassive liver necrosis) were 15%, 33%, and 44% at 3, 5, and 7 years, respectively, and among these patients, 52% developed decompensated liver disease during the follow-up and 36% lost their grafts. The biochemical severity at the onset of the recurrent hepatitis and the development of cholestasis or cytomegalovirus disease were independent predictors of severe HCV-related graft damage. No differences were found in graft and patient survival when positive-HCV OLT recipients were compared with a coetaneous cohort of 215 non-HCV OLT recipients.


CONCLUSIONS
HCV infection recurrence leads to severe liver damage and subsequently to clinical decompensation in a significant proportion of OLT recipients. Some clinical and biochemical characteristics can predict the severity of HCV-induced graft damage.
Sánchez-Fueyo
Alberto
A
Liver Unit, Hospital Clínic, University of Barcelona, Villarroel 170, Barcelona 08036, Spain.
Restrepo
Juan Carlos
JC
Quintó
Llorenç
L
Bruguera
Miquel
M
Grande
Luís
L
Sánchez-Tapias
José María
JM
Rodés
Joan
J
Rimola
Antoni
A
D001707:Biopsy, Needle; D016001:Confidence Intervals; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival / Q000502:physiology*; D006526:Hepatitis C / Q000473:pathology / Q000503:physiopathology*; D006650:Histocompatibility Testing; D006801:Humans; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000276:immunology / Q000401:mortality / Q000473:pathology / Q000502:physiology*; D008297:Male; D009336:Necrosis; D012008:Recurrence; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors