Hepatic steatosis: A specific sign of hepatitis C reinfection after liver transplantation

Hepatitis C virus (HCV) infection is one of the major causes leading to ort hotopic liver transplantation (OLT) worldwide, Although viral infection per sists in almost all patients, the pathology of recurrent HCV infection afte r OLT is not well characterized. To address this issue, we compared the pat hological findings of 28 patients who underwent transplantation for HCV-rel ated cirrhosis (group A, aged 47 +/- 15 years; 23 men, 5 women) with those of 21 patients who underwent transplantation for nonviral indications (grou p B, aged 45 +/- 21 years; 13 men; 8 women) during the first year after tra nsplantation, Patients from group A were assessed for serum HCV RNA by 5' u ntranslated region nested polymerase chain reaction before and 1 year after OLT. Patients underwent protocol liver biopsies 3 months and 1 year after transplantation. Group A patients more frequently had histological evidence of hepatic steatosis than group B patients, both at 3 months (P = .003) an d 1 year (P = .003) after OLT. Fibrosis and portal inflammation were statis tically more frequent in group A 1 year after transplantation. The sensitiv ity of steatosis in detecting histological disease recurrence was 100% at 3 months and 94% at 1 year; the specificity was 40% and 60%, respectively. C onversely, steatosis was 100% specific in detecting viral recurrence, with a sensitivity of 89%, The 1-year actuarial incidence of abnormal transamina se levels was 52% in group A and 13% in group B (P = .05). No biochemical o r histological differences between patients infected with genotype 1b and p atients with other HCV genotypes were found. Hepatic steatosis is a specifi c sign of viral recurrence after liver transplantation and a less specific sign of disease recurrence. HCV-infected liver transplant recipients often develop abnormal transaminase levels and liver fibrosis 1 year after OLT; t hese features are unrelated to HCV genotypes, (C) 1998 by the American Asso ciation for the Study of Liver Diseases.