RECURRENCE OF HEPATITIS-C FOLLOWING ORTHOTOPIC LIVER-TRANSPLANTATION - A POLYMERASE CHAIN-REACTION AND HISTOLOGICAL STUDY

Hepatitis C virus was sought by nested polymerase chain reaction in th e preoperative biopsy or the explanted liver of 100 consecutive adult patients undergoing orthotopic liver transplantation. In those found t o be positive preoperatively, polymerase chain reaction was performed on subsequent biopsies. Of the 12 patients in whom HCV-RNA was identif ied in the liver by polymerase chain reaction preoperatively, viral re currence was documented in ten of the 11 with posttransplant liver tis sues available for study. In the one exception, hepatitis C virus was undetectable in the liver graft despite repeated co-amplification of a lbumin mRNA as an internal control, which may indicate viral clearance . In eight of the ten positive cases, HCV-RNA was also detectable in s erum postoperatively, while HCV-RNA was undetectable in serum in both the cases in whom HCV-RNA was undetectable in tissue and in the patien t who declined post-transplant biopsy. Two of the 12 patients infected with hepatitis C virus preoperatively have died during the follow-up period from causes unrelated to hepatitis C virus infection. While bio chemical liver function in seven of those remaining has been excellent , histological evidence of at least mild chronic active hepatitis has been present in all ten cases for whom long-term biopsies are availabl e. Three cases have progressed to severe, symptomatic chronic active h epatitis within 2 years of transplantation. Recurrent hepatitis C is a ssociated with progressive liver disease and appreciable morbidity in a significant proportion of patients. (C) Journal of Hepatology.