Hepatitis C genotypes in liver transplant recipients: Distribution and 1-year follow-up

Abstract

Chronic hepatitis C infection (CH-C) accounts for a significant number of patients undergoing orthotopic liver transplantation (OLT). Recently, hepatitis C virus (HCV) genotype-dependent differences in disease outcome and therapeutic responses have been suggested. The objectives of our study were to determine (1) the recurrence of HCV infection after OLT; (2) distribution of HCV genotypes in patients with CH-C who required liver transplantation compared with those who did not; and (3) the 1-year transplantation outcome in patients infected with different hepatitis C genotypes. RNA was extracted from sera of 20 patients who underwent OLT for end-stage liver disease secondary to CH-C (group I) and 52 patients with CH-C who did not require OLT (group II). For viral RNA detection, reverse transcriptase and polymerase chain reaction (RT/PCR) of 5'UT region was performed on all OLT patients both before and after OLT. For genotyping, RT-PCR of the NS 5 region was performed, followed by automated sequencing of the amplification products. Nineteen OLT patients had viral RNA detected by PCR both before and after OLT. One patient had no RNA detected before OLT but became viremic after OLT. The prevalence of HCV genotype 1b was significantly higher in group I patients compared with group II (53% v 23% respectively, P = .01). Examination of outcome at 1 year after OLT showed that 9 of 10 patients with HCV genotype 1b had histological evidence of hepatitis compared with 4 of 9 patients with other genotypes (non-1b) (P = .06). However, the number of patients who had one or more episodes of rejection, underwent retransplantation, or died at 1 year after OLT were similar. Recurrence of HCV infection after OLT was shown in all studied patients. Hepatitis C genotype 1b is more prevalent in our patients who underwent transplantation compared with a group with chronic hepatitis C who did not require transplantation (P = .01). Patients infected with HCV genotype 1b may have a higher risk of histological hepatitis after transplantation.

Outcome ofDe Novohepatitis C virus infection in heart transplant recipients

“…In addition to our series, several other case reports of severe cholestatic hepatitis after receiving hearts from HCVantibody positive donors have been reported. [21][22][23][24][25] This pattern of liver injury is reminiscent of the fibrosing cholestatic hepatitis in recurrent hepatitis B virus infection 26 …”

Genotype 1b and severity of posttransplant recurrence of hepatitis C infection? unconvictable felon or wrongly accused?

“…If genotype 1b is associated with more severe allograft injury, this should eventually become manifest in patient and/or graft survival. Neither the previous studies that found HCV genotype 1b to be associated with more severe chronic allograft injury [8][9][10][11][12][13] nor the Eurohep report found an association of genotype 1b with increased overall graft loss or patient mortality. The National Institute of Diabetes and Digestive and Kidney Diseases Liver Transplant Database, in a large multicenter prospective study of liver transplantation for hepatitis C, found 5-year patient graft survival to be similar among 1b and non-1b genotypes.…”

“…Previous reports of the impact of HCV genotype on outcomes in HCVinfected transplant recipients have been varied. Several groups reported that infection with HCV genotype 1b imparts an increased risk for more severe chronic allograft injury, [8][9][10][11][12][13] whereas others found no such association. [14][15][16] The basis of the heterogeneity in the results regarding the impact of HCV genotypes on the risk for more severe histological recurrence is difficult to ascertain.…”

Nested Restriction Site-Specific PCR To Detect and Type Hepatitis C Virus (HCV): a Rapid Method To Distinguish HCV Subtype 1b from Other Genotypes

“…39,2001 NESTED RSS-PCR FOR HEPATITIS C VIRUSresults presented above. Of the 54 strains found by RSS-PCR to have the genotype 1b pattern, 46 (85%) had 5Ј NC region sequence that was 100% identical to the corresponding 5Ј NC region sequence of prototype strain HCV-J.…”

“…Amoroso et al (1) found that the rate of progression to chronic infection after acute exposure to HCV was 92% among patients who were infected with genotype 1b, whereas that rate was 33 to 50% among those infected with strains of other genotypes. Zein et al (37,39) found that genotype 1b strains occurred significantly more frequently among patients with cirrhosis and those patients requiring liver transplantation. Patients infected with genotype 1b and possibly genotype 1a may have a more unfavorable response to treatment with interferon than those infected with genotypes 2 or 3 (38).…”