Early identification of recipients with progressive histologic recurrence of hepatitis C after liver transplantation

Approximately half of patients undergoing liver transplantation (LT) for he patitis C virus (HCV) develop histologic evidence of recurrence within the first postoperative year. Early identification of recipients at risk for mo re severe recurrence of HCV may be useful in selecting patients for antivir al therapy. We determined whether recipients at greatest risk for more seve re recurrence of HCV can be identified by pre- and/or early post-LT HCV-RNA levels in serum or tissue. Serum and tissue samples were prospectively col lected pre-LT and at 7 days, 4 months, 1 year, and at 3 years posttransplan tation from patients undergoing LT for HCV. Hepatitis activity index (HAI) and fibrosis stage (FS) were assessed in all liver biopsies. Forty-seven pa tients (32 men) were studied. Higher HCV-RNA levels at 4 months post-LT (gr eater than or equal to 10(9) copies/mL, n = 29) were associated with higher HAI at 1 year and at 3 years post-LT, The HAI seen on protocol biopsies at 4 months correlated significantly with fibrosis stage (FS) at 1 year (r = .56, P less than or equal to .001) and 3 years (r = .53, P = .002). Higher HCV-RNA levels at 7 days and 4 months post-LT were sensitive (66% and 84%, respectively) and specific (92% and 63%, respectively) in identifying recip ients with an HAI greater than 3 at 3 years. Higher pre- and early post-LT HCV-RNA levels are associated with more severe recurrence of HCV. The corre lation of early HAI with subsequent FS suggests that higher mean HAI will e ventually translate into more advanced stages of fibrosis. Patients at risk for more severe post-LT recurrence of HCV can be identified by early postt ransplant HCV-RNA levels.