Detection of HCV antigens in liver graft: Relevance to the management of recurrent post-liver transplant hepatitis C

Alberto Grassi, Chiara Quarneti, Matteo Ravaioli, Francesco Bianchini, Micaela Susca, Antonia D'Enrrico, Fabio Piscaglia, Maria Rosa Tamè, Pietro Andreone, GianLuca Grazi, Silvia Galli, Daniela Zaull, Antonio D. Pinna, Francesco B. Bianchi, Giorgio Ballardini

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Abstract

The aim of this study was to evaluate how the immunohistochemical detection of liver hepatitis C virus (HCV) antigens (HCV-Ag) could support the histologic diagnosis and influence the clinical management of post-liver transplantation (LT) liver disease. A total of 215 liver specimens from 152 HCV-positive patients with post-LT liver disease were studied. Histologic coding was: hepatitis (126), rejection (34), undefined (24; coexisting rejection grade I and hepatitis), or other (31). The percentage of HCV-Ag infected hepatocytes were evaluated, on frozen sections, by an immunoperoxidase technique. HCV-Ag were detectable early in 57% of cases within 30 days post-LT, 92% of cases between 31 and 180 days, and 74% of cases after more than 180 days. Overall, HCV-Ag were detected more frequently in histologic hepatitis as compared to rejection (P <0.0001) with a higher percentage of positive hepatocytes (P <0.00001). In 16 patients with a high number of HCV-Ag-positive hepatocytes (65%; range 40-90%) a clinical diagnosis of recurrent hepatitis (RHC) was made despite inconclusive histopathologic diagnosis. Multivariate analysis identified the percentage of HCV-Ag-positive hepatocytes and the time post-LT as independent predictors for RHC (P = 0.008 and P = 0.041, respectively) and the number of HCV-Ag-positive hepatocytes ≥50% as the only independent predictor for nonresponse (P <0.001) in 26 patients treated with α-interferon plus ribavirin. In conclusion, HCV reinfection occurs early post-LT, reaching its peak within 6 months. Immunohistochemical detection of post-LT HCV reinfection support the diagnosis of hepatitis when the histologic features are not conclusive. A high number of infected cells, independently from the genotype, represents a negative predictive factor of response to antiviral treatment.

Original languageEnglish
Pages (from-to)1673-1681
Number of pages9
JournalLiver Transplantation
Volume12
Issue number11
DOIs
Publication statusPublished - Nov 2006

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ASJC Scopus subject areas

  • Surgery
  • Transplantation

Cite this

Grassi, A., Quarneti, C., Ravaioli, M., Bianchini, F., Susca, M., D'Enrrico, A., Piscaglia, F., Tamè, M. R., Andreone, P., Grazi, G., Galli, S., Zaull, D., Pinna, A. D., Bianchi, F. B., & Ballardini, G. (2006). Detection of HCV antigens in liver graft: Relevance to the management of recurrent post-liver transplant hepatitis C. Liver Transplantation, 12(11), 1673-1681. https://doi.org/10.1002/lt.20882