Long-term outcome of hepatitis C virus infections acquired after pediatric liver transplantation

✍ Scribed by Carla Venturi; Javier Bueno; Lluís Castells; Jesus Quintero; Isabel Casas; Helena Allende; Vicente Martinez-Ibañez; Ramón Charco

• Publisher: John Wiley and Sons
• Year: 2011
• Tongue: English
• Weight: 110 KB
• Volume: 17
• Category: Article
• ISSN: 1527-6465
• DOI: 10.1002/lt.22439

✦ Synopsis

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 6 4.3 years, and the median time from transplantation to the diagnosis of HCV was 15.1 years (range ¼ 0.2-19.7 years). The genotypes were 1 (n ¼ 8), 3 (n ¼ 1), and undetermined (n ¼ 1). At the time of this writing, all the patients were still alive with a mean follow-up of 7.3 6 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. Liver Transpl 17:1474-1480, 2011. V C 2011 AASLD.