The influence of viral genotypes and rejection episodes on the recurrence of hepatitis C after liver transplantation.
OBJECTIVE
The aim of this study was to report the influence of hepatitis C virus (HCV) genotype and rejection episodes on the outcome of orthotopic liver transplantation (OLT), hepatitis recurrence, and progression to graft cirrhosis after OLT.


METHODS
Fifty-three patients who all had undergone OLT for end-stage liver cirrhosis were selected for this study. Hepatitis C genotype was determined. Recurrent hepatitis and rejection were diagnosed based on elevated liver function tests and a liver biopsy.


RESULTS
The patients were followed up for a mean of 51.9 +/- 34.3 months. The cumulative survival rate was no different in OLT for hepatitis C and OLT for all other liver diseases. After OLT, serum HCV RNA was detected in 93%. Histological recurrence occurred in 85% of all patients. The 1-, 3-, and 5-year recurrence rates were 48%, 77%, and 85%, respectively. Of the 41 patients with recurrent hepatitis C, 4 (10%) had cirrhosis, 18 (44%) had hepatitis with fibrosis, and 91 (46%) had hepatitis without fibrosis at the end of follow-up. A total of 32% of the patients were infected by HCV genotype 1b and 68% by other HCV genotypes. The recurrence rates were significantly higher in patients infected with genotype 1b than in those with other genotypes ( p = 0.04). Twenty of 48 patients (42%) experienced acute rejection. There was a strong association between the number of rejection episodes and the incidence of HCV-related cirrhosis ( p < 0.01).


CONCLUSIONS
Our findings showed the genotype 1b to result in a higher recurrence rate after OLT. On the other hand, rejection episodes were associated with a more rapid progression to graft cirrhosis.
Sugo
Hiroyuki
H
The Queensland Liver Transplant Service, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Qld 4102, Australia.
Balderson
Glenda A
GA
Crawford
Darrell H G
DH
Fawcett
Jonathan
J
Lynch
Stephen V
SV
Strong
Russell W
RW
Futagawa
Shunji
S
D000328:Adult; D000368:Aged; D005260:Female; D005838:Genotype; D006084:Graft Rejection; D016174:Hepacivirus / Q000235:genetics*; D006526:Hepatitis C / Q000209:etiology*; D006801:Humans; D008103:Liver Cirrhosis / Q000209:etiology / Q000821:virology; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D016019:Survival Analysis