Recurrence of hepatitis C virus (genotype 4) infection after living-donor liver transplant in Egyptian patients.
OBJECTIVE
The recurrence of hepatitis C virus infection after liver transplant is common and may endanger both graft and patient survival. We investigated the frequency and outcome of and risk factors for the recurrence of that virus after living-donor liver transplant in hepatitis C virus positive recipients.


METHODS
Seventy-four adult hepatitis C virus positive subjects were monitored for 36 months after living-donor liver transplant and demographic and laboratory data for the recipients and donors were evaluated. Recurrent hepatitis C virus infection was diagnosed on the basis of viral replication revealed by polymerase chain reaction after transplant, elevated levels of transaminases, and the results of liver biopsy.


RESULTS
Hepatitis C virus recurrence was identified in 31.1% of the patients studied. Histopathologic recurrence was mild, and 91% of the subjects had a fibrosis score of < or = F2. No recipient exhibited cirrhosis or clinical decompensation during followup. Recurrent hepatitis C virus infection was associated with pretransplant and posttransplant viral load and antibody positive to hepatitis B core antigen. No other risk factors (sex, donor or recipient age, pretransplant Child-Pugh or Model for End-Stage Liver Disease scores, immunosuppressive drug therapy, and treatment with pulse steroids) were significantly correlated with the frequency of hepatitis C virus recurrence, the grade of the histologic activity index, or the stage of fibrosis.


CONCLUSIONS
In living-donor liver transplant recipients, patient and graft survival rates associated with hepatitis C virus (genotype 4) related cirrhosis were comparable to those in deceased-donor liver transplant recipients reported in the literature. Recurrent infection with hepatitic C virus after living-donor liver transplant was mild. After transplant, a higher viral load and the presence of antibody to hepatitis B core antigen could be risk factors for hepatitis C virus recurrence. Long-term follow-up in a large number of patients is required.
Yosry
Ayman
A
Liver Transplantation Center, Dar Al-Fouad Hospital, Giza, Egypt. ayosry@tedata.net.eg
Abdel-Rahman
Mahasen
M
Esmat
Gamal
G
El-Serafy
Magdy
M
Omar
Ashraf
A
Doss
Waheed
W
Zayed
Nagla
N
Said
Mohamed
M
Ismail
Tamer
T
Hosny
Adel
A
Marawan
Ebrahem
E
El-Malt
Osama
O
Kamel
Refaat Refaat
RR
Hatata
Yaser
Y
El-Taweel
Ahmad
A
Ghali
Ahmad
A
Sabri
Hussein
H
Kamel
Sanaa
S
El-Gabaly
Hatem
H
D000328:Adult; D001706:Biopsy; D044383:Black People / Q000706:statistics & numerical data*; D006528:Carcinoma, Hepatocellular / Q000208:ethnology / Q000473:pathology / Q000601:surgery* / Q000821:virology; D004534:Egypt / Q000453:epidemiology; D005260:Female; D005838:Genotype; D016174:Hepacivirus / Q000235:genetics* / Q000276:immunology; D006510:Hepatitis B Antibodies / Q000097:blood; D006512:Hepatitis B Core Antigens / Q000276:immunology; D006526:Hepatitis C / Q000150:complications* / Q000175:diagnosis / Q000208:ethnology; D006801:Humans; D008103:Liver Cirrhosis / Q000208:ethnology / Q000473:pathology / Q000601:surgery* / Q000821:virology; D008113:Liver Neoplasms / Q000208:ethnology / Q000473:pathology / Q000601:surgery* / Q000821:virology; D016031:Liver Transplantation / Q000208:ethnology*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood; D012008:Recurrence; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load; D014779:Virus Replication
D006510:Hepatitis B Antibodies; D006512:Hepatitis B Core Antigens; D012367:RNA, Viral