HEPATITIS-C VIRUS REINFECTION IN ORTHOTOPIC LIVER-TRANSPLANT PATIENTSWITH OR WITHOUT CONCOMITANT HEPATITIS-B INFECTION

Although recurrence of hepatitis C virus (HCV) in orthotopic liver tra nsplant (OLT) patients is frequent, the relationship between HCV recur rence and graft pathology, particularly in patients who also have a hi story of hepatitis B virus (HBV), is unclear. The recurrence of HCV af ter OLT was determined by reverse transcriptase-nested polymerase chai n reaction (RT-PCR) in the sera and livers of 41 patients with OLT, 32 of whom underwent transplants for HCV or HBV-related disease. Results were compared with liver function tests, liver histology (including H BV immunohistochemistry), and antibody status. HCV PCR was more freque ntly positive in OLT patients with a history of HCV only (59%) than in those with a history of both HCV and HBV (41%) or no history of viral infection (2%). Recurrent HCV (60% overall) was associated with mild elevation of liver function tests and mild to moderate hepatitis. In p atients who underwent transplants for both HCV and HBV disease, hepati tis on biopsy was more frequently associated with recurrent HBV than w ith recurrent HCV. We conclude that graft reinfection with HCV, which is frequent in OLT patients with or without HBV recurrence, is usually associated with only mild to moderate hepatitic changes compatible wi th graft survival.