BIOCHEMICAL AND HISTOLOGIC EVALUATION OF RECURRENT HEPATITIS-C FOLLOWING ORTHOTOPIC LIVER-TRANSPLANTATION

It is well recognized that hepatitis recurs in virtually all patients who undergo orthotopic liver transplantation for cirrhosis secondary t o chronic hepatitis C (HCV). The present report describes the biochemi cal and histologic findings of recurrent hepatitis in 25 such patients . One patient was found to have hepatocellular carcinoma at the time o f OLT and was excluded fi om further analysis. Ah post-OLT laboratory values were reviewed. Liver biopsies were performed on protocol 6, 12, 24, and 36 months following OLT. Additional biopsies were performed a s necessary to evaluate abnormalities in serum Liver chemistries. A to tal of 104 biopsies was obtained; hepatitis consistent with recurrent HCV was present in 68 (65%). Other biopsy findings included cytomegalo virus hepatitis; acute, chronic, or resolving rejection; cholestasis w ith or without an underlying hepatitis; steatosis, and centrilobular n ecrosis. Histologic hepatitis appeared in all patients within 12 month s following OLT. Despite these histologic findings, serum ALT was norm al for prolonged periods in over 50% of such patients. In all cases th is hepatitis was mild and did not progress over a mean follow-up of 22 months (maximum 44 months), as judged by Knodell histologic activity score (mean score: 4.0+/-0.3). Five patients developed cholestatic jau ndice, far out of proportion to the degree of histologic hepatitis. In 2 patients this was secondary to chronic rejection. The other 3 patie nts had drug-induced cholestasis that resolved after various medicatio ns were discontinued. HCV did not contribute to graft dysfunction in a ny of the 24 patients. To date, our data suggest that post-OLT hepatit is in patients with preexisting HCV is a relatively benign process. Se vere cholestatic jaundice in such patients is not secondary to HCV, an d should stimulate a search for other possible causes of graft dysfunc tion. The long-term consequences of recurrent HCV following hepatic tr ansplantation remain to be determined.