THE COURSE OF HEPATITIS-C VIRUS-INFECTION AFTER LIVER-TRANSPLANTATION

Hepatitis C virus-induced liver disease is becoming a main indication for liver transplantation. Recurrence of hepatitis after transplantati on has been reported, but its long-term consequences are unknown. Seve nty-nine patients positive for hepatitis C virus (group 1) and 106 sub jects negative for hepatitis C virus antibody (group 2) with a mean fo llow-up of 4 yr were retrospectively studied by means of serology, nes ted polymerase chain reaction and branched-DNA technology before and a fter liver transplantation. The actuarial rates of hepatitis C virus-r elated acute hepatitis were 72% and 20% at 4 yr in groups 1 and 2, res pectively. Progression to chronic active hepatitis occurred in 61% and 36% of the subjects within 3 yr of the onset of recurrent and acquire d hepatitis, respectively. No case of acute graft failure and two case s of cirrhosis were related to recurrent or acquired hepatitis C virus liver disease. Hepatitis C virus RNA levels were significantly increa sed in cases of hepatitis after transplantation. In contrast, the pret ransplant hepatitis C virus RNA level was not predictive of recurrence . Our results establish the general persistence of hepatitis C virus i nfection after liver transplantation, the frequency and the severe cou rse of recurrent liver disease. However, liver transplantation in hepa titis C virus antibody-positive patients still has a good medium-term prognosis.