Host and donor risk factors before and after liver transplantation that impact HCV recurrence

Abstract

Key Points 1. The natural history of hepatitis C after liver transplantation is variable. Several factors, including those related to the virus, the host, the environment and the donor, are probably implicated in the outcome. 2. The immune status per se likely represents the main significant variable in influencing disease severity in hepatitis C virus-infected patients. Findings that support this statement include the higher aggressivity of hepatitis C in immunocompromised liver transplant recipients as compared with that observed in immunocompetent patients, both before and after the development of compensated cirrhosis, and the significant association described between the degree of immunosuppression and disease severity.

Digital image analysis of collagen assessment of progression of fibrosis in recurrent HCV after liver transplantation

“…Fibrosis progression before [9,10] and after transplantation has prognostic significance: rapid fibrosis and early cirrhosis are associated with hepatic decompensation [11][12][13] and poor survival [14]. Therefore, determination of CPA fibrosis progression rate could be prognostically useful.…”

Glucocorticosteroids Increase Cell Entry by Hepatitis C Virus

“…Several factors have been suspected to be accountable including an increased donor age 5 . Generally, HCV RNA levels are higher after transplantation than before and high virus titers are associated with a worse long term outcome 6 , 7 .…”

Management of Recurrent HCV and HBV Infections after Liver Transplantation

“…Initially, there was some concern that HCV recurrence was more severe with live donor transplant, but a growing experience did not confirm these findings (Gallegos-Orozco et al, 2009 Among the baseline viral characteristics some relationship was noted between genotype 1 of the virus and the patient and graft survival, but the predominance of genotype 1 among transplanted patients can be explained by the worse antiviral treatment results before and after transplantation in comparison with other genotypes, therefore negative impact of genotype 1 on the severity of HCV recurrence was not clearly determined. It was already mentioned that high pretransplant viremia, but also persistence of the same HCV variants are responsible for more severe picture of acute HCV reinfection and more progressive course of chronic HCV disease (Berenguer, 2003).…”