HEPATITIS-C VIRUS GENOTYPES IN LIVER-TRANSPLANT RECIPIENTS - IMPACT ON POSTTRANSPLANT RECURRENCE, INFECTIONS, RESPONSE TO INTERFERON-ALPHA THERAPY AND OUTCOME

Background. End-stage liver disease due to hepatitis C virus (HCV) is the most common indication for liver transplantation in U.S. veterans. We investigated the influence of HCV genotypes on the incidence and t iming of recurrent HCV hepatitis, survival, infectious morbidity, and response to interferon-alpha therapy in this unique patient population . Methods. HCV genotype was determined by direct sequencing of the NS5 region of HCV with type-specific primers. Results. Genotype la (66%, 32/47) was the predominant genotype. Type Ib was found in 25% (12/47) of patients and type 2b was found in 9% (4/41), Histopathologically re current HCV hepatitis developed in 53% (25/47) of the patients after t ransplantation. This group included 45% (14/31) of the patients with t ype la, 67% (8/12) of the patients with type Ib, and 25% (1/4) of the patients with type 2b (P>0.5). The time to recurrence and the severity of HCV recurrence as defined by aminotransferase levels or Knodell sc ores were not different among the three genotypes. There was a trend t oward a higher incidence of major infections in patients with type Ib (75%) versus type la (48%) and type 2b (50%) (P=0.11). The response to interferon-alpha therapy did not differ significantly among the genot ypes, Mortality at 5 years was 16% (5/31) in patients with genotype la , 42% (5/12) in patients with genotype Ib, and 50% (2/4) in patients w ith genotype 2b (P=0.06), Conclusions. The incidence, time to recurren ce, and response to interferon-alpha therapy did not differ between th e various genotypes in our liver transplant recipients. However, there was a trend toward higher infectious morbidity and overall mortality in patients with genotype Ib after transplantation.