title: Long-term outcome of hepatitis C virus infections acquired after pediatric liver transplantation.
abstract: The outcomes and characterization of hepatitis C virus (HCV) infections after pediatric liver transplantation (LT) have rarely been reported. We describe our experience with HCV infections after pediatric LT. Ten of 207 children (4.8%) who underwent LT at our institution (1985-2010) developed previously undiagnosed HCV disease. Eight received a liver graft before blood product and donor screening for HCV became available. The mean age at transplantation was 8.9 ± 4.3 years, and the median time from transplantation to the diagnosis of HCV was 15.1 years (range = 0.2-19.7 years). The genotypes were 1 (n = 8), 3 (n = 1), and undetermined (n = 1). At the time of this writing, all the patients were still alive with a mean follow-up of 7.3 ± 5.5 years after the diagnosis of HCV. Five patients did not receive treatment; 2 of these patients achieved spontaneous viral clearance (SVC). Four of the 5 treated patients achieved a sustained virological response, and 3 had an early virological response (EVR). Two of these 4 patients developed chronic rejection while they were on treatment, but this was resolved with a conversion from cyclosporine A to tacrolimus. The remaining patient was continuing treatment and had achieved EVR. In conclusion, despite the limitations of our series, de novo HCV infections after pediatric LT seem to have a slow histological progression. Even with genotype 1, the patients have a good long-term prognosis and respond well to treatment. Nevertheless, chronic rejection during antiviral therapy may develop. In addition, SVC may occur in this population.
authors.affiliation: Pediatric Surgery and Transplant Unit, Saint Luc University Clinics, Brussels, Belgium.
authors.forename: Carla
authors.initials: C
authors.lastname: Venturi
authors.forename: Javier
authors.initials: J
authors.lastname: Bueno
authors.forename: Lluís
authors.initials: L
authors.lastname: Castells
authors.forename: Jesus
authors.initials: J
authors.lastname: Quintero
authors.forename: Isabel
authors.initials: I
authors.lastname: Casas
authors.forename: Helena
authors.initials: H
authors.lastname: Allende
authors.forename: Vicente
authors.initials: V
authors.lastname: Martinez-Ibañez
authors.forename: Ramón
authors.initials: R
authors.lastname: Charco
mesh_terms: D000293:Adolescent; D000998:Antiviral Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D006084:Graft Rejection / Q000209:etiology / Q000517:prevention & control; D016174:Hepacivirus / Q000235:genetics / Q000276:immunology; D006526:Hepatitis C / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D018937:Hepatitis C Antibodies / Q000097:blood; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D012367:RNA, Viral / Q000097:blood; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D000998:Antiviral Agents; D015415:Biomarkers; D018937:Hepatitis C Antibodies; D007166:Immunosuppressive Agents; D012367:RNA, Viral