High levels of hepatitis C virus RNA in native livers correlate with the development of cholestatic hepatitis in liver allografts and a poor outcome

A subset of hepatitis C virus (HCV)-positive liver transplant recipients de velop cholestatic hepatitis (CH). We investigated the role of pretransplant ation disease activity (estimated by Knodell score and HCV RNA quantitation ) in the native liver explant on the development of CH and graft and patien t outcome. Eight patients with CH were identified among HCV-positive liver transplants and were compared with 20 consecutive patients with recurrent H CV hepatitis of noncholestatic type in liver transplants. We evaluated all 28 explanted native livers histologically using the Knodell scoring system. HCV viral load was measured in the native explant and 5 allograft explants from the CH group using Amplicor HCV RNA Monitor test. Six of 8 patients w ith CH had HCV RNA levels of 5,000 copies/mug of DNA or greater in the nati ve liver explant, whereas only 1 of the control group had viral loads great er than this level. Greater HCV RNA levels correlated with worse graft and patient survival (P < .001). The 3-year survival rate in the CH group was 1 8% compared with 77% in the control group (P < .001). There was no differen ce in the primary immunosuppressive regimens used in the 2 groups. We concl ude that (1) CH has a uniformly poor prognosis, (2) type of immunosuppressi ve therapy appears to have little influence on the development of CH, (3) h igh pretransplantation HCV RNA levels in the native explant may predict the development of CH, and (4) patients with high HCV RNA levels in the explan ted native liver may be appropriate candidates for antiviral therapy to pre vent the development of CH.