PRETRANSPLANT VIROLOGICAL MARKERS HEPATITIS C VIRUS GENOTYPE AND VIREMIA LEVEL ARE NOT HELPFUL IN PREDICTING INDIVIDUAL OUTCOME AFTER ORTHOTOPIC LIVER TRANSPLANTATION

Autor: Hartmut Lobeck, Peter Neuhaus, Andrea R. Müller, Wolf O. Bechstein, Thomas Berg, Ruth Neuhaus, Uwe Hopf, Takumi Fukumoto
Rok vydání: 1998
Předmět:
Zdroj: Transplantation. 66:225-228
ISSN: 0041-1337
DOI: 10.1097/00007890-199807270-00015
Popis: Background. Recurrence of hepatitis C viremia after orthotopic liver transplantation (OLT) is nearly universal, leading to variable outcome from no to severe recurrent disease. In the present study, the prognostic relevance of hepatitis C virus (HCV) genotypes and viremia for the development and severity of graft hepatitis was investigated. Methods. A total of 79 patients with chronic hepatitis C who could be followed for 1 to 78 months (mean: 30 months) after OLT were included in this study. HCV RNA concentrations were measured before OLT, 1 month after OLT, as well as in the long-term follow-up after OLT in 54 of the 79 patients. Results. Graft hepatitis could be documented in 40 of the 79 patients (51%), and 7 of them (9%) progressed to liver cirrhosis. More severe forms of graft hepatitis predominated in patients with subtype 1b infection, and all seven patients with progression to liver cirrhosis had subtype 1b (P5NS). Neither the pretransplant nor the posttransplant HCV RNA levels were significantly associated with the occurrence of graft hepatitis. However, there was a trend of more severe recurrent disease in subtype 1b-infected patients with high level viremia in the early course after OLT. Conclusions. Pretransplant HCV virological markers are not helpful to predict the outcome after OLT. However, it should be further investigated whether estimation of HCV genotype and viremia levels very early after OLT, i.e., within the first weeks, may be a better approach to recognize high-risk patients. Orthotopic liver transplantation (OLT*) has become a wellestablished treatment for end-stage liver diseases with excellent results for short-term survival, with a 30-day mortality of 3% at our center. The recurrence of the liver disease is now one of the most important problems in liver transplantation. Patients chronically infected with hepatitis C virus (HCV) before OLT will suffer graft reinfection in nearly all cases, and graft hepatitis of mild to moderate activity will occur in about 50 ‐70% (1‐5). However, in some patients, HCV reinfection induces a progressive disease leading to graft failure even within 1 year (6, 7). The mechanisms responsible for these different outcomes are still unclear. HCV genotype and hepatitis C viremia may influence the clinical course. In particular, an association between genotype 1b and manifestation of severe recurrent hepatitis C could be observed, and it was suggested that genotype 1b may play a major role in this respect (8, 9). Furthermore, the relevance of the hepatitis C viremia level for the development of graft hepatitis has also been discussed, but it seems that the evaluation of the preOLT HCV RNA concentration is of little help in this respect (10 ‐12).
Databáze: OpenAIRE
Externí odkaz: