The Course of Hepatitis C Virus Infection After Liver Transplantation

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Abstract
Hepatitis C virus—induced liver disease is becoming a main indication for liver transplantation. Recurrence of hepatitis after transplantation has been reported, but its long–term consequences are unknown. Seventynine patients positive for hepatitis C virus (group 1) and 106 subjects negative for hepatitis C virus antibody (group 2) with a mean follow–up of 4 yr were retrospectively studied by means of serology, nested polymerase chain reaction and branched–DNA technology before and after liver transplantation. The actuarial rates of hepatitis C virus—related acute hepatitis were 72% and 20% at 4 yr in groups 1 and 2, respectively. Progression to chronic active hepatitis occurred in 61% and 36% of the subjects within 3 yr of the onset of recurrent and acquired hepatitis, respectively. No case of acute graft failure and two cases of cirrhosis were related to recurrent or acquired hepatitis C virus liver disease. Hepatitis C virus RNA levels were significantly increased in cases of hepatitis after transplantation. In contrast, the pretransplant hepatitis C virus RNA level was not predictive of recurrence. Our results establish the general persistence of hepatitis C virus infection after liver transplantation, the frequency and the severe course of recurrent liver disease. However, liver transplantation in hepatitis C virus antibody—positive patients still has a good medium–term prognosis. (Hepatology 1994;20:1137-1143).