Carrier states without significant laboratory abnormali-We analyzed the long-term clinical course of 71 paties are observed in approximately 16%, biochemical abtients with RNA-positive hepatitis C virus (HCV) infecnormalities without symptoms are seen in 60%, and tion after liver transplantation. Patients with reinfecsymptomatic disease develops in a quarter of the pation after transplantation for HCV-related liver disease, tients. The disease course closely resembles that seen in or de novo infection at transplantation were followed for nontransplanted hepatitis C patients. It is generally up to 12 years. Cumulative survival for patients with mild but little over 10% of patients develop signs of fibro-HCV infection at 2, 5, and 10 years after transplantation sis of the graft during the first decade. (HEPATOLOGY was 67%, 62%, and 62%, respectively. It was not signifi-1997;25:203-210.) cantly different from that in patients transplanted for other nonmalignant diseases without HCV infection.
The main factor determining long-term survival was the Hepatitis C is a major cause of chronic liver disease worldwide. In industrialized countries approximately 0.5% to 1.5% presence or absence of hepatocellular carcinoma (HCC) at transplantation. The 5-year survival rate for HCV pa-of the general population carry the virus, 1 and up to 50% of those infected develop chronic hepatitis, leading to substan-tients with or without HCC was 35% versus 73%, respectively (P õ .05). No deaths because of viral hepatitis of tial morbidity and mortality. 2 Spontaneous remission is a rare event with a likelihood of only 0.6 per 100 patient years, 3 the graft were observed. Deaths in the first year after transplantation were caused by infectious complica-and cirrhosis will eventually develop in a large proportion of chronic hepatitis C virus (HCV) carriers. Additionally, a tions, cardiovascular problems, or rejection; deaths after more than 12 months were exclusively because of recur-number of cryptogenic cases of cirrhosis may in fact be caused by the HCV. 4 Hepatitis C infection is also a major risk factor rence of HCC. Biochemical and histological evidence of hepatitis was found in the majority of the patients, only for the development of hepatocellular carcinoma. 5 Thus HCVrelated liver disease has become one of the major indications 16% had normal alanine aminotransferase (ALT) values throughout. Twenty-two percent of patients complained for liver transplantation, currently accounting for approximately 15% to 20% of transplantations at our institution. of symptoms, with hepatitis C being the cause in 82% of these. Two patients lost their HCV-RNA for prolonged, Previous studies have established that reinfection of the grafted liver with HCV occurs in the majority of patients ongoing periods of time. The severity of the posttransplantation hepatitis was unrelated to age, sex, severity within the first weeks after transplantation. [6][7][8][9] Clinical and histological signs of hepatitis develop in more than 60% of of liver disease before transplantation, cold ischemic time of the graft, duration of the operation, transfusions, patients within 1 year, 6,[10][11][12] and rapid development of fibrosis and cirrhosis has been observed in some patients. 13 However, the number of rejection episodes, or the long-term immunosuppressive regime. Only initial short-term ther-in most of the infected individuals the initial course of posttransplantation hepatitis C is mild and only rarely leads to apy with interleukin 2 (IL2) receptor antibodies adversely influenced inflammatory activity. Viral genotype significant symptoms.
In contrast, the long-term prognosis of posttransplantation did not influence the course of the graft hepatitis in our series. Histology showed inflammation in 88% of the bi-hepatitis C is still unclear. Reported series so far have only followed patients for up to 5 years, and most of them for even opsies and signs of fibrosis in 24%. Mean ALT values correlated with inflammation but not with fibrosis in shorter periods of time. 7,14 We therefore studied the clinical, biochemical, and histological course of 71 patients with HCV the biopsies. Porto-portal bridging was observed in six patients, one patient developed cirrhosis within 2 years infection after liver transplantation that were followed for up to 12 years. after orthotopic liver transplantation (OLT). We conclude that chronic hepatitis develops in the majority of PATIENTS AND METHODS patients with HCV infection after liver transplantation.
Long-time survival, clinical course, laboratory liver function tests, and histology of the graft were analyzed in patients with HCV infection after liver transplantation. Patients were included only, if they Abbreviations: HCV, hepatitis C virus; PCR, polymerase chain reaction; OLT, orthotopic were found to be HCV-RNA positive by polymerase chain reaction liver transplantation; HBV, hepatitis B virus; ALT, alanine transaminase; g-GT, g-glutamyl (PCR) and stayed HCV-RNA positive for more than 90 days after transaminase; HCC, hepatocellular carcinoma.