title: Viral load 1 week after liver transplantation, donor age and rejections correlate with the outcome of recurrent hepatitis C.
abstract: BACKGROUND
  Early identification of patients at a higher risk of rapidly progressive recurrent hepatitis post liver transplantation (LT) could help to tailor antiviral therapy.
  
  
  METHODS
  We studied the correlation between early post-LT viral load and the histological and clinical outcomes of 49 consecutive patients (34 males, median age 55 years) in whom viraemia was monitored at days 0, 1, 7, 30, 180 and 365 after LT.
  
  
  RESULTS
  Hepatitis C recurred at histology in 38 of 42 (90.5%) patients. Early viral load after LT was higher in patients with rapidly progressive hepatitis C recurrence (day 7 median HCV-RNA levels: 5.84 vs 4.93 Log(10) IU/ml, P=0.003). Day 7 HCV-RNA levels >/=2.5 x 10(5) IU/ml, donor age >60 years and rejection episodes were independently associated with progression to cirrhosis within one year post-LT [P=0.018, odds ratio (OR) 27.59; P=0.043, OR 13.85 and P=0.048, OR 9.95, respectively]. Day 7 viraemia and rejection episodes were independently associated with 5-years survival. Day 7 viraemia, in combination with acute hepatitis and/or donor age, showed 80% sensitivity, 94% specificity and 90.5% diagnostic accuracy to identify severe recurrence.
  
  
  CONCLUSIONS
  Early post-LT HCV-RNA correlates with the severity of hepatitis C recurrence and in combination with donor age (>60 years) and rejections, identifies patients with a high risk of severe recurrence and candidates of cost-effective pre-emptive antiviral therapy.
authors.affiliation: U.O. Gastroenterologia e Epatologia, Pisa, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Ciccorossi
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Maina
authors.forename: Filippo
authors.initials: F
authors.lastname: Oliveri
authors.forename: Stefania
authors.initials: S
authors.lastname: Petruccelli
authors.forename: Gioacchino
authors.initials: G
authors.lastname: Leandro
authors.forename: Piero
authors.initials: P
authors.lastname: Colombatto
authors.forename: Francesco
authors.initials: F
authors.lastname: Moriconi
authors.forename: Franco
authors.initials: F
authors.lastname: Mosca
authors.forename: Franco
authors.initials: F
authors.lastname: Filipponi
authors.forename: Ferruccio
authors.initials: F
authors.lastname: Bonino
authors.forename: Maurizia Rossana
authors.initials: MR
authors.lastname: Brunetto
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000097:blood / Q000821:virology*; D019698:Hepatitis C, Chronic / Q000821:virology*; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood*; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors; D019562:Viral Load
chemical_list: D012367:RNA, Viral