Hepatitis Central

HCV Viremia, Genotype

Not linked to disease severity

Viral factors appear to be predictive of Hepatitis C virus-recurrent disease but not disease severity in patients who have undergone liver transplantation for hepatitis-related cirrhosis.

"We found that Hepatitis C virus (HCV) infection recurs in practically all patients after orthotopic liver transplantation (OLT) for HCV-cirrhosis," researcher J. Crespo and colleagues wrote ("Hepatitis C Virus Recurrence after Liver Transplantation: Relationship to Anti-HCV Core IgM, Genotype, and Level of Viremia," The American Journal of Gastroenterology, September 1997;92(9):1458-1462). "Moreover, most patients have recurrent hepatitis; this recurrence may be associated with high levels of HCV viremia before OLT and IgM positivity."

HCV-related cirrhosis is a common indication for OLT, and repeated studies have found that HCV recurs immediately in virtually all such patients.

"Despite the nearly universal recurrence of HCV viremia, the recurrent hepatitis varies - ranging from 14 percent to 100 percent of the cases (Shiftman et al., Transplantation 1994;57:526-532; Belli et al., Lancet 1993;341:378-379)," Crespo et al. wrote. "Furthermore, it has been observed that the development of acute hepatitis and subsequent chronic hepatitis occurs faster in some patients than in others. Why some patients develop recurrent hepatitis in a few weeks while others progress to it in several months or years is unknown."

In addition to these concerns, the factors that determine the severity of the disease have not been clearly identified. Higher levels of serum HCV RNA in the post-OLT period and certain HCV genotypes may be associated with more severe liver disease after transplantation, but reports have been conflicting.

In this study, Crespo et al. investigated the natural history of HCV recurrent liver disease after OLT in 25 patients to determine the relation of clinical and virological factors before and after OLT to the probability of recurrent disease and its severity in the graft.

HCV RNA was detected by qualitative and quantitative polymerase chain reaction (PCR). The HCV genotype also was determined by PCR. Anti-HCV core IgM was tested by ELISA and disease severity was expressed as a histological score.

Sixteen patients had evidence of HCV-recurrent disease. HCV RNA levels before transplantation (p= 0.029) and after transplantation (15 days, p= 0.004; 90 days, p= 0.040; 360 days, p= 0.010) were significantly higher among patients who subsequently developed recurrent hepatitis than among those who did not.

The presence of anti-HCV core IgM before (p= 0.044) and after OLT (15 days, p= 0.017; 90 days, p= 0.037; and 360 days, p= 0.040) was significantly related to recurrence of hepatitis. The genotype was not related to the level of viremia, to the prevalence of recurrent hepatitis, to the presence of anti-HCV core IgM, or to disease severity.

Crespo et al. concluded that the recurrence of HCV hepatitis in patients undergoing OLT for HCV cirrhosis is related to higher levels of viremia and the presence of anti-HCV core IgM, but not to the HCV genotype. However, disease severity is not related to viremia levels, HCV genotype, or positivity of anti-HCV core IgM.

"Anti-core HCV IgM may be useful in the assessment of the risk of HCV recurrent liver disease in patients undergoing OLT for Hepatitis C," Crespo et al. wrote.

The corresponding author for this study is J. Crespo, Gastroenterology and Hepatology Unit, University Hospital Marques de Valdecilla, Santander, Spain.

- by Salynn Boyles, Senior Editor
Transplantation, October 27, 1997