Serum hepatitis C virus RNA levels and histologic findings in liver allografts with early recurrent hepatitis C

Background.-Histopathologic features of early recurrent hepatitis C after o rthotopic liver transplantation (OLTx) may be modified by immunosuppressive therapy or complicated by other conditions. Hepatitis C virus (HCV) RNA le vel usually increases after OLTx, but its correlation to histologic finding s is not clear. Objective.-To evaluate the histologic findings of early recurrent hepatitis C in liver allografts and its correlation to serum HCV RNA level. Methods.-We studied 14 patients who underwent OLTx for chronic HCV infectio n. Thirty liver biopsy specimens and HCV RNA levels of 22 corresponding pla sma samples obtained during the first 6 months following OLTx were analyzed . The control group (9 patients, 25 biopsy specimens) was chosen at random from patients with chronic liver disease other than HCV who were undergoing OLTx, and all tested negative for HCV RNA by polymerase chain reaction aft er OLTx. Results.-Statistically significant pathological features of early recurrent HCV infection were the number of acidophilic bodies, piecemeal necrosis, l ymphocyte predominance in the portal tracts, and fibrous septum. These find ings and histologic activity index scores increased with time after OLTx. T he HCV RNA levels determined by branched DNA assay showed no significant co rrelation with histologic features, However, patients with higher histologi c activity index scores tended to have higher RNA levels. Conclusions.-Liver biopsy specimens are helpful for the diagnosis or confir mation of early recurrent hepatitis C in liver allografts, but serial biops y specimens are sometimes required for definite diagnosis. The HCV RNA leve ls are usually higher in patients who display signs of more severe liver da mage.