Hepatitis C virus reinfection in allografts after orthotopic liver transplantation

Abstract

From September 1988 to May 1991, 160 orthotopic liver transplantations were performed in our hospital. Twenty-four patients had end-stage cirrhosis caused by chronic non-A, non-B hepatitis. Antibodies against hepatitis C virus were documented before and after orthotopic liver transplantation in 13 patients. Studies using the polymerase chain reaction demonstrated hepatitis C virus RNA in the serum and liver tissue of 17 patients (10 of whom tested positive for hepatitis C virus antibodies) before orthotopic liver transplantation. Tissue samples taken from liver grafts during the operation were hepatitis C virus RNA negative in every case. Ten of these 17 patients had positive hepatitis C virus RNA findings in serum and liver biopsy specimens within the first month after surgery. One patient died of Mucor sepsis 2 mo after orthotopic liver transplantation. Another patient died of multi-organ failure 3 mo after a retransplantation. Two patients underwent retransplantation for graft rejection at 2 and 3 mo, respectively. One year after orthotopic liver transplantation, hepatitis C virus RNA was demonstrated in allograft biopsy specimens in 13 of 15 patients. Two patients remained hepatitis C virus RNA negative in repeated biopsies up to 12 mo. Mild portal and lobular hepatitis developed within 6 months of orthotopic liver transplantation in four patients and within 1 yr in five additional patients. The data suggest that persistent hepatitis C virus reinfects the allograft in most cases, but the risk of acute organ damage caused by hepatitis C virus reinfection is low.

Applications and Limitations of Blood Eosinophilia for the Diagnosis of Acute Cellular Rejection in Liver Transplantation

“…All patients who are HCV RNA positive before transplant remain positive afterwards and 50-80% develops recurrent hepatitis in the graft (10,12). Distinguishing early HCV re-infection from ACR is notoriously problematic.…”

“…Hepatitis C infection is the most common indication for transplantation in our unit and in many others, and recurrent hepatitis C infection occurs in all patients early after transplantation and is notoriously difficult to distinguish from ACR (10)(11)(12). In this study we assessed blood eosinophilia in patients with and without HCV infection and a histological diagnosis of ACR to establish if eosinophilia occurred with the same frequency in the two groups.…”

Polymerase chain reaction and in situ hybridization of Epstein-Barr virus in liver biopsy specimens facilitate the diagnosis of EBV hepatitis after liver transplantation

“…Changes compatible with viral infection, such as enlarged cells and acidophilic bodies, were only seldom observed; they are unspecific and correlated not only with EBV but also with CMV in this study. In addition, sinusoidal lymphocytic-histiocytic infiltrates are reported in other types of viral hepatitis, such as hepatitis C virus [20,27].…”

Cytokine profile of liver- and blood-derived nonspecific T cells after liver transplantation: T helper cells type 1/0 lymphokines dominate in recurrent hepatitis C virus infection and rejection

“…[1][2][3][4][5][6] Histopathologic features of recurrent HCV infection may be modified by immunosuppressive therapy and may hardly be distinguishable from allograft rejection. 3,4,7 The mechanisms leading to tissue damage are not well understood, but T cells and their lymphokines are believed to have a decisive role in the pathogenesis.…”