Post-transplant quasispecies pattern remains stable over time in patients with recurrent cholestatic hepatitis due to hepatitis C virus

Background/Aims: Several studies have shown that cholestatic recurrent hepa titis is associated with very high HCV RNA loads in liver transplant recipi ents. The aim of this study was to investigate whether a correlation exists between cholestatic hepatitis posttransplant and the population of viral q uasispecies, Methods: One hundred and nine serial sera samples were tested from 15 recurrent HCV patients. Four of these patients showed severe choles tatic recurrent hepatitis, 11 patients demonstrated non-cholestatic recurre nt hepatitis post-transplant. Quasispecies were detected by RT-PCR amplific ation of the HVR1 followed by single-stranded conformational polymorphism a nalysis, Results: Forty-one samples from four cholestatic patients were tested. All four patients showed very stable quasispecies patterns post-transplant. One cholestatic patient also showed a stable quasispecies band pattern followi ng retransplantation, again associated with severe cholestatic hepatitis. S ixty-eight samples were tested from the 11 non-cholestatic patients. In con trast, these patients showed significantly more quasispecies bands than the cholestatic patients. The non-cholestatic patients also displayed fluctuat ing band patterns post-transplant, Serial samples were tested after retrans plantation in one non-cholestatic patient, with a fluctuating pattern again seen. There was a negative correlation between the HCV RNA load in serum a nd the number of quasispecies bands. Conclusions: Stable hepatitis C viral quasispecies associated with persiste ntly high viral load in post-transplant cholestatic hepatitis suggest that viral escape from immune pressures may play a role in the pathogenesis of t his condition.