Detection of HCV antigens in liver graft: Relevance to the management of recurrent post-liver transplant hepatitis C

✍ Scribed by Alberto Grassi; Chiara Quarneti; Matteo Ravaioli; Francesco Bianchini; Micaela Susca; Antonia D'Errico; Fabio Piscaglia; Maria Rosa Tamè; Pietro Andreone; GianLuca Grazi; Silvia Galli; Daniela Zauli; Antonio D. Pinna; Francesco B. Bianchi; Giorgio Ballardini

• Publisher: John Wiley and Sons
• Year: 2006
• Tongue: English
• Weight: 263 KB
• Volume: 12
• Category: Article
• ISSN: 1527-6465
• DOI: 10.1002/lt.20882

✦ Synopsis

The aim of this study was to evaluate how the immunohistochemical detection of liver hepatitis C virus (HCV) antigens (HCV-Ag) could support the histologic diagnosis and influence the clinical management of post-liver transplantation (LT) liver disease. A total of 215 liver specimens from 152 HCV-positive patients with post-LT liver disease were studied. Histologic coding was: hepatitis (126), rejection (34), undefined (24; coexisting rejection grade I and hepatitis), or other (31). The percentage of HCV-Ag infected hepatocytes were evaluated, on frozen sections, by an immunoperoxidase technique. HCV-Ag were detectable early in 57% of cases within 30 days post-LT, 92% of cases between 31 and 180 days, and 74% of cases after more than 180 days. Overall, HCV-Ag were detected more frequently in histologic hepatitis as compared to rejection (P Ͻ 0.0001) with a higher percentage of positive hepatocytes (P Ͻ 0.00001). In 16 patients with a high number of HCV-Ag-positive hepatocytes (65%; range 40-90%) a clinical diagnosis of recurrent hepatitis (RHC) was made despite inconclusive histopathologic diagnosis. Multivariate analysis identified the percentage of HCV-Ag-positive hepatocytes and the time post-LT as independent predictors for RHC (P ϭ 0.008 and P ϭ 0.041, respectively) and the number of HCV-Ag-positive hepatocytes Ն50% as the only independent predictor for nonresponse (P Ͻ 0.001) in 26 patients treated with ␣-interferon plus ribavirin. In conclusion, HCV reinfection occurs early post-LT, reaching its peak within 6 months. Immunohistochemical detection of post-LT HCV reinfection support the diagnosis of hepatitis when the histologic features are not conclusive. A high number of infected cells, independently from the genotype, represents a negative predictive factor of response to antiviral treatment.