Background: The hepatitis C virus (HCV) is one of the major etiological agents of end-stage liver diseases requiring liver transplantation (OLT). Recent studies have demonstrated that: 1) HCV reinfection after OLT is almost universal, 2) HCV viremia increases with immunosuppression, 3) more than 50% of viremic patients develop allograft hepatitis, 4) patients with persistent alterations of ALT levels are at higher risk of allograft hepatitis at histological examination. The purpose of this study was to evaluate the dynamics of viremia and the clinical evolution of HCV infection in a group of patients with long-term follow-up, transplanted between 1986 and 1994. Methods: Routine tests for the diagnosis of HBV and HDV infections were used. Antibodies against HCV were assayed using the ELISA and RIBA assays. For HCV-RNA detection, a polymerase chain reaction (PCR) was employed. Results: Sixty-one patients were anti-HCV positive after OLT (mean follow-up: 52 ± 31 months): 49 (80.3%) were anti-HCV positive pre-OLT and 12 (19.7%) experienced de novo infection. The actuarial survival was 97, 88 and 74% at 1, 5 and 9 years, respectively. Patients HBsAg positive pre-OLT had significantly better survival rates when coinfected with the HCV. Patients anti-HCV positive after OLT experienced persistent or intermittent elevations of ALT levels in most cases. Of note, 62.5% of patients with ALT > 2 x N for a time period > 6 months after OLT had histologic evidence of allograft hepatitis. Seriated post-OLT determinations of HCV-RNA were available in 51 patients: 6 (11.8%) were HCV-RNA negative, while 45 (88.2%) resulted HCV-RNA positive at least once. Fluctuations of viremia were frequent. The number of viremic plasma samples significantly increased after > 90 days post-OLT, but progressively decreased in the late follow-up. Conclusions: In conclusion, patients carrying the HCV were at high risk of reinfection after OLT. The survival rates were good in the mid-term, and HCV coinfection had a beneficial effect on the survival of patients HBsAg positive pre-OLT. Patients anti-HCV positive post-OLT with persistent alterations of ALT levels were at risk of developing allograft hepatitis. The HCV-RNA reappeared early in the serum. The number of viremic samples significantly increased after > 3 months post-OLT, but progressively decreased in the late follow-up.
|Translated title of the contribution||Hepatitis C virus infection after orthotopic liver transplantation|
|Number of pages||10|
|Publication status||Published - 1998|
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