Recurrence of hepatitis C virus genotype-4 infection following orthotopic liver transplantation: Natural history and predictors of outcome

Abstract

BACKGROUND AND OBJECTIVES:There are few reports on hepatitis C virus genotype 4 (HCV-4) recurrences after orthotopic liver transplantation (OLT). Therefore, we undertook a study to determine the epidemiological, clinical and virological characteristics of patients with biopsy-proven recurrent HCV infection and analyzed the factors that influence recurrent disease severity. We also compared disease recurrence and outcomes between HCV-4 and other genotypes.PATIENTS AND METHODS:All patients who underwent OLT (locally or abroad) for HCV related hepatic cirrhosis from 1991 to 2006 and had recurrent HCV infection were identified. Clinical, laboratory and pathological data before and after OLT were collected and analyzed.RESULTS:Of 116 patients who underwent OLT for hepatitis C, 46 (39.7%) patients satisfied the criteria of recurrent hepatitis C. Twenty-nine (63%) patients were infected with HCV genotype 4. Mean (SD) for age was 54.9 (10.9) years. Nineteen of the HCV genotype 4 patients (65.5%) were males, 21 (72.4%) received deceased donor grafts, and 7 (24.1%) developed ≥1 acute rejection episodes. Pathologically, 7 (24.1%) and 4 (13.8%) patients had inflammation grade 3-4 and fibrosis stage 3-4, respectively. Follow-up biopsy in 9 (31%) HCV genotype 4 patients showed stable, worse and improved fibrosis stage in 5, 2 and 2 patients, respectively. Of the 7 patients in the recurrent HCV group who died, 6 were infected with genotype 4 and 4 of them died of HCV-related disease.CONCLUSION:This analysis suggests that HCV recurrence following OLT in HCV-4 patients is not significantly different from its recurrence for other genotypes.

Management of hepatitis C virus genotype 4: Recommendations of An International Expert Panel

“…On the other hand, studies from the Middle East show a more favorable outcome of HCV-4 patients. In a study from Saudi Arabia on biopsy proven recurrence HCV post-OLT there were no significant differences between genotype 1 and 4 patients in terms of epidemiological, clinical, and histological factors as well as outcome (patients and graft survival) [127]. Among many epidemiologic, laboratory, virologic factors included in that analysis, the only factor predictive of an advanced histological score was the HCV RNA level at the time of biopsy.…”

Treatment of Genotype 4 Hepatitis C Recurring After Liver Transplantation Using a Combination of Pegylated Interferon Alfa-2a and Ribavirin

“…We have previously compared the recurrence and outcome between HCV genotype 4 and other genotypes following liver transplantation [18]. In that study, there was no significant difference in the 3-year survival, histological disease staging, and graft loss when comparing patients with genotype 4 to other genotypes.…”

Liver Transplantation and HCV Genotype 4

“…They found that in the initial liver biopsy, which was performed after a mean time from transplantation of more than 2 years, there were only four patients who had fibrosis scores greater than stage 3. Two of these patients progressed to cirrhosis on subsequent biopsies [54]. Among many factors included in that analysis, the only factor predictive of an advanced histological score was the HCV RNA level at the time of biopsy.…”