Quantification of C4d deposition and hepatitis C virus RNA in tissue in cases of graft rejection and hepatitis C recurrence after liver transplantation

Abstract

Histology is the gold standard for diagnosing acute rejection and hepatitis C recurrence after liver transplantation. However, differential diagnosis between the two can be difficult. We evaluated the role of C4d staining and quantification of hepatitis C virus (HCV) RNA levels in liver tissue. This was a retrospective study of 98 liver biopsy samples divided into four groups by histological diagnosis: acute rejection in patients undergoing liver transplant for hepatitis C (RejHCV+), HCV recurrence in patients undergoing liver transplant for hepatitis C (HCVTx+), acute rejection in patients undergoing liver transplant for reasons other than hepatitis C and chronic hepatitis C not transplanted (HCVTx-). All samples were submitted for immunohistochemical staining for C4d and HCV RNA quantification. Immunoexpression of C4d was observed in the portal vessels and was highest in the HCVTx- group. There was no difference in C4d expression between the RejHCV+ and HCVTx+ groups. However, tissue HCV RNA levels were higher in the HCVTx+ group samples than in the RejHCV+ group samples. Additionally, there was a significant correlation between tissue and serum levels of HCV RNA. The quantification of HCV RNA in liver tissue might prove to be an efficient diagnostic test for the recurrence of HCV infection.

Clinicopathologic Characteristics of Late Acute Antibody-mediated Rejection in Pediatric Liver Transplantation

“…C4d immunostaining is the most widely used marker of AMR in renal and cardiac transplantation. However, previous studies 21-23 indicate that C4d immunostaining in liver allografts are neither sensitive nor specific. C4d immunostaining patterns vary with different antibodies.…”

HCV-RNA quantification in liver bioptic samples and extrahepatic compartments, using the abbott Real Time HCV assay

“…The post-OLT detection of HCV-RNA in the serum or graft is extremely common, occurring in more than 95% of cases (Berenguer, 2002). During post-OLT follow up, elevated liver enzymes warrant liver biopsies for accurate diagnosis and treatment and it can be difficult to differentiate between acute rejection and recurrence of hepatitis C (Song et al, 2015). HCV treatment before OLT may reduce or eliminate the risk of post-OLT recurrence.…”