RECURRENT HEPATITIS-C VIRUS HEPATITIS IN LIVER-TRANSPLANT RECIPIENTS RECEIVING TACROLIMUS - ASSOCIATION WITH REJECTION AND INCREASED IMMUNOSUPPRESSION AFTER TRANSPLANTATION

Background. Recurrent hepatitis C virus hepatitis is associated with s ignificant morbidity and mortality after liver transplantation. Howeve r, the risk factors for clinical recurrence including the role of reje ction and immunosuppression have nor been defined in patients receivin g tacrolimus (FK506) as primary immunosuppression. Methods. Sixty-six consecutive adult liver transplant recipients receiving tacrolimus as primary immunosuppression were monitored; 31 of 66 underwent transplan tation for end-stage liver disease caused by hepatitis C virus. Median follow-up for the patients in the study was 3 1/2 years. Recurrent he patitis C virus hepatitis determined on histopathologic evaluation dev eloped in 58% (18 of 31). A number of clinical variables including rej ection and intensity of immunosuppression were assessed for patients w ith and without recurrence. Results. Rejection episodes preceding recu rrence were documented in 72% (13 of 18) of patients with recurrence c ompared with 23% (3 of 13) in those without recurrence (p = 0.007). A total of 33% (5 of 15) of patients with no rejection experienced recur rence versus 83% (5 of 6) with one episode of rejection (p = 0.06) and 80% (8 of 10) with more than one episode of rejection (p = 0.04). The mean number of steroid boluses for the treatment of rejection was hig her for patients with recurrence (2.3 versus 0.77, p = 0.01). Overall immunosuppression (as measured by steroid boluses, recycles, OKT3, and azathioprine) was significantly more intense for patients with recurr ence (p = 0.013). Conclusions. Greater rejection concurrent with incre ased immunosuppression was associated with a higher recurrence of hepa titis C in liver transplant recipients.