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  • Longitudinal variation in hepatitis C virus (HCV) viraemia and early course of HCV infection after liver transplantation for HCV cirrhosis: the role of different immunosuppressive regimens

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Liver disease
Longitudinal variation in hepatitis C virus (HCV) viraemia and early course of HCV infection after liver transplantation for HCV cirrhosis: the role of different immunosuppressive regimens
  1. G V Papatheodoridisa,
  2. S G R G Bartona,
  3. D Andrewb,
  4. G Clewleyb,
  5. S Daviesc,
  6. A P Dhillonc,
  7. G Dusheikoa,
  8. B Davidsona,
  9. K Rollesa,
  10. A K Burroughsa
  1. aLiver Transplantation Unit, Royal Free Hospital, London, UK, bDepartment of Virology, Royal Free Hospital, London, UK, cDepartment of Histopathology, Royal Free Hospital, London, UK
  1. Dr A K Burroughs, Liver Transplantation and Hepatobiliary Medicine, Royal Free Hospital, Pond Street, London NW3 2QG, UK.

Abstract

BACKGROUND The role of the type of immunosuppression in the natural history of post-transplant hepatitis C virus (HCV) infection is unclear.

AIMS To evaluate the fluctuation of HCV viraemia and the early course of infection, and their relation to the type of immunosuppression in HCV transplant patients.

METHODS In 47 HCV transplant patients, serum HCV RNA levels were determined pretransplant and at one and two weeks, and three and 12 months after transplant. Initial immunosuppression was triple (cyclosporin, azathioprine, prednisolone) in 31, double (cyclosporin, prednisolone) in five, and single (cyclosporin or tacrolimus) in 11 patients. Prednisolone was withdrawn at a median of six months.

RESULTS At three months, HCV RNA levels were higher in patients with single than with triple or double initial therapy. At 12 months, HCV RNA levels correlated only with duration of prednisolone treatment and were relatively higher in patients with triple compared with single initial immunosuppression. A higher necroinflammatory activity at 12 months post-transplant was found in patients with post-transplant acute hepatitis compared with those without. Extent of fibrosis at 12 months was associated with the 12 month HCV RNA level and occurrence of post-transplant acute hepatitis.

CONCLUSIONS HCV RNA levels at three months after transplant are higher in patients treated with single initial immunosuppressive therapy, but at 12 months are higher in patients with longer duration of steroid treatment. HCV viraemia at 12 months seems to be particularly important, as its levels are strongly correlated with the severity of fibrosis.

  • HCV RNA
  • HCV genotype
  • grading score
  • staging score
  • immunosuppression
  • liver transplantation

  • Abbreviations used in this paper

    CMV
    cytomegalovirus
    HCV
    hepatitis C virus
    OLT
    orthotopic liver transplantation
    PCR
    polymerase chain reaction

    • https://doi.org/10.1136/gut.45.3.427

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    • Abbreviations used in this paper

      CMV
      cytomegalovirus
      HCV
      hepatitis C virus
      OLT
      orthotopic liver transplantation
      PCR
      polymerase chain reaction
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