HEPATIC STEATOSIS - A SPECIFIC SIGN OF HEPATITIS-C REINFECTION AFTER LIVER-TRANSPLANTATION

Hepatitis C virus (HCV) infection is one of the major causes leading t o orthotopic liver transplantation (OLT) worldwide, Although viral inf ection persists in almost all patients, the pathology of recurrent HCV infection after OLT is not well characterized. To address this issue, we compared the pathological findings of 28 patients who underwent tr ansplantation for HCV-related cirrhosis (group A, aged 47 +/- 15 years ; 23 men, 5 women) with those of 21 patients who underwent transplanta tion for nonviral indications (group B, aged 45 +/- 21 years; 13 men; 8 women) during the first year after transplantation, Patients from gr oup A were assessed for serum HCV RNA by 5' untranslated region nested polymerase chain reaction before and 1 year after OLT. Patients under went protocol liver biopsies 3 months and 1 year after transplantation . Group A patients more frequently had histological evidence of hepati c steatosis than group B patients, both at 3 months (P = .003) and 1 y ear (P = .003) after OLT. Fibrosis and portal inflammation were statis tically more frequent in group A 1 year after transplantation. The sen sitivity of steatosis in detecting histological disease recurrence was 100% at 3 months and 94% at 1 year; the specificity was 40% and 60%, respectively. Conversely, steatosis was 100% specific in detecting vir al recurrence, with a sensitivity of 89%, The 1-year actuarial inciden ce of abnormal transaminase levels was 52% in group A and 13% in group B (P = .05). No biochemical or histological differences between patie nts infected with genotype 1b and patients with other HCV genotypes we re found. Hepatic steatosis is a specific sign of viral recurrence aft er liver transplantation and a less specific sign of disease recurrenc e. HCV-infected liver transplant recipients often develop abnormal tra nsaminase levels and liver fibrosis 1 year after OLT; these features a re unrelated to HCV genotypes, (C) 1998 by the American Association fo r the Study of Liver Diseases.