Recurrent hepatitis B, hepatitis C, and combined hepatitis B and C in liver allografts: A comparative pathological study

Although recurrence of viral hepatitis in liver transplants is common, data comparing recurrent hepatitis B (HB), hepatitis C (HC), and co-existing du al hepatitis B and C (HB&C) are sparse. Posttransplantation liver biopsies, along with molecular, serological, immunohistochemical, and clinical data from 27 patients with pretransplantation diagnosis of chronic viral hepatit is, were reviewed. The patients were placed into 4 groups: Group I, with pr etransplantation HE (n = 8); group II, with pretransplantation MC (n = 10); group III, with pretransplantation HC and anti-MB surface or core antibody (n = 4); and group TV, with pretransplantation HB&C (n = 5). The histopath ologic findings and patient outcome were compared in the 4 groups. A high r ate of recurrence of viral hepatitis was seen for all 4 groups: Group I = 1 00%, group II = 90%, Group III = 100%, and group IV = 80%, with the mean (m edian) recurrence time of 308 (224), 82 (52), 61 (64), and 125 (70) days, r espectively. The number of deaths (their median survival times) were: group I = 4 (374 days), group LI = 4 (794 days), group III = 1 (1,143 days), and group IV = 5 (448 days). The earliest histological findings of lobular inj ury was the presence of acidophil bodies and Kupffer cell hyperplasia, the latter being more prominent in recurrent HC cases. Recurrent HE presented i n 2 forms: early (before 150 days) with poor survival and with either sever e necroinflammatory histology or with features of fibrosing cholestatic hep atitis, and delayed (after 150 days), with mild necro-inflammatory activity and prolonged survival. HC with or without anti-MB antibodies had early re currence, but the course was slowly progressive. Patients with HB&C had rec urrence of both viruses; however, the course was dictated by HE virus. HUM PATHOL 31:101-108. Copyright (C) 2000 by W.B. Saunders Company.