title: Using an immune functional assay to differentiate acute cellular rejection from recurrent hepatitis C in liver transplant patients.
abstract: In transplant recipients transplanted for hepatitis C, presentation of abnormal transaminases can herald the presentation of recurrent hepatitis C, cellular rejection, or both. Given the sometimes ambiguous histology with these 2 entities, the ability to distinguish them is of great importance because misinterpretation can potentially affect graft survival. We used an immune functional assay to help assess the etiology of abnormal liver function test results in liver transplant recipients. Blood samples for the immune functional assay were taken from 42 recipients prospectively at various times post-transplant and compared with clinical and histologic findings. In patients whose liver biopsy showed evidence of cellular rejection, the immune response was noted to be very high, whereas in those with active recurrence of hepatitis C, the immune response was found to be very low. This finding was found to be statistically significant (P < 0.0001). In those patients in whom there was no predominant histologic features suggesting 1 entity over the other, the immune response was higher than in those with aggressive hepatitis C but lower than in those with cellular rejection. In conclusion, these data show the potential utility of the ImmuKnow assay as a means of distinguishing hepatitis C from cellular rejection and its potential usefulness as a marker for outlining the progression of hepatitis C.
authors.affiliation: Hepatobiliary Section, Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Florida, Gainesville, FL 32610, USA.
authors.forename: Roniel
authors.initials: R
authors.lastname: Cabrera
authors.forename: Miguel
authors.initials: M
authors.lastname: Ararat
authors.forename: Consuelo
authors.initials: C
authors.lastname: Soldevila-Pico
authors.forename: Lisa
authors.initials: L
authors.lastname: Dixon
authors.forename: Jen-Jung
authors.initials: JJ
authors.lastname: Pan
authors.forename: Roberto
authors.initials: R
authors.lastname: Firpi
authors.forename: Victor
authors.initials: V
authors.lastname: Machicao
authors.forename: Cynthia
authors.initials: C
authors.lastname: Levy
authors.forename: David
authors.initials: D
authors.lastname: Nelson
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Morelli
mesh_terms: D000328:Adult; D000368:Aged; D003937:Diagnosis, Differential; D005260:Female; D006084:Graft Rejection / Q000276:immunology* / Q000473:pathology*; D006085:Graft Survival; D006526:Hepatitis C / Q000276:immunology* / Q000473:pathology*; D006801:Humans; D008111:Liver Function Tests; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012720:Severity of Illness Index