Outcome of Recurrent Hepatitis C Based on Viral Load 1 Week Post Transplant
Outcome of Recurrent Hepatitis C Based on Viral Load 1 Week Post Transplant
Background: Early identification of patients at a higher risk of rapidly progressive recurrent hepatitis post liver transplantation (LT) could help to tailor antiviral therapy.
Methods: We studied the correlation between early post-LT viral load and the histological and clinical outcomes of 49 consecutive patients (34 males, median age 55 years) in whom viraemia was monitored at days 0, 1, 7, 30, 180 and 365 after LT.
Results: Hepatitis C recurred at histology in 38 of 42 (90.5%) patients. Early viral load after LT was higher in patients with rapidly progressive hepatitis C recurrence (day 7 median HCV-RNA levels: 5.84 vs 4.93 Log10 IU/ml, P=0.003). Day 7 HCV-RNA levels ≥2.5 x 10 IU/ml, donor age >60 years and rejection episodes were independently associated with progression to cirrhosis within one year post-LT [P=0.018, odds ratio (OR) 27.59; P=0.043, OR 13.85 and P=0.048, OR 9.95, respectively]. Day 7 viraemia and rejection episodes were independently associated with 5-years survival. Day 7 viraemia, in combination with acute hepatitis and/or donor age, showed 80% sensitivity, 94% specificity and 90.5% diagnostic accuracy to identify severe recurrence.
Conclusions: Early post-LT HCV-RNA correlates with the severity of hepatitis C recurrence and in combination with donor age (>60 years) and rejections, identifies patients with a high risk of severe recurrence and candidates of cost-effective pre-emptive antiviral therapy.
Liver transplantation (LT) is a life-saving option for patients with decompensated liver disease and/or hepatocellular carcinoma (HCC) associated with chronic Hepatitis C virus (HCV) infection. Unfortunately, LT is not a cure for hepatitis C as recurrence of viral infection is almost universal and liver damage occurs in most cases. Recurrent hepatitis C is the leading cause of graft loss and retransplantation. Many factors such as donor characteristics (age, living donor and donor-recipient matching), virologic features, acute rejection episodes and immune suppression were shown to influence the progression of posttransplant liver disease. Particularly, the dynamics of HCV infection after LT appears to play a major role in the outcome of disease recurrence and several studies reported that viraemia levels in post transplant patients are significantly higher than before LT. However, it remains controversial whether early or late virologic events are more relevant on disease outcome: some authors suggested that higher viraemia levels in the early months after LT accelerate progression of liver disease; others showed a significant correlation between liver fibrosis and higher viraemia levels later on during follow-up. Thus, the current challenge is a better understanding of HCV infection dynamics in LT patients to optimize the management of hepatitis C recurrence by a proper timing and tailoring of antiviral therapy in the single patient. In this study, we investigated the relations between HCV-RNA kinetics during the first year after LT and the severity of the outcome of recurrent hepatitis C and 5-year graft survival.
Background: Early identification of patients at a higher risk of rapidly progressive recurrent hepatitis post liver transplantation (LT) could help to tailor antiviral therapy.
Methods: We studied the correlation between early post-LT viral load and the histological and clinical outcomes of 49 consecutive patients (34 males, median age 55 years) in whom viraemia was monitored at days 0, 1, 7, 30, 180 and 365 after LT.
Results: Hepatitis C recurred at histology in 38 of 42 (90.5%) patients. Early viral load after LT was higher in patients with rapidly progressive hepatitis C recurrence (day 7 median HCV-RNA levels: 5.84 vs 4.93 Log10 IU/ml, P=0.003). Day 7 HCV-RNA levels ≥2.5 x 10 IU/ml, donor age >60 years and rejection episodes were independently associated with progression to cirrhosis within one year post-LT [P=0.018, odds ratio (OR) 27.59; P=0.043, OR 13.85 and P=0.048, OR 9.95, respectively]. Day 7 viraemia and rejection episodes were independently associated with 5-years survival. Day 7 viraemia, in combination with acute hepatitis and/or donor age, showed 80% sensitivity, 94% specificity and 90.5% diagnostic accuracy to identify severe recurrence.
Conclusions: Early post-LT HCV-RNA correlates with the severity of hepatitis C recurrence and in combination with donor age (>60 years) and rejections, identifies patients with a high risk of severe recurrence and candidates of cost-effective pre-emptive antiviral therapy.
Liver transplantation (LT) is a life-saving option for patients with decompensated liver disease and/or hepatocellular carcinoma (HCC) associated with chronic Hepatitis C virus (HCV) infection. Unfortunately, LT is not a cure for hepatitis C as recurrence of viral infection is almost universal and liver damage occurs in most cases. Recurrent hepatitis C is the leading cause of graft loss and retransplantation. Many factors such as donor characteristics (age, living donor and donor-recipient matching), virologic features, acute rejection episodes and immune suppression were shown to influence the progression of posttransplant liver disease. Particularly, the dynamics of HCV infection after LT appears to play a major role in the outcome of disease recurrence and several studies reported that viraemia levels in post transplant patients are significantly higher than before LT. However, it remains controversial whether early or late virologic events are more relevant on disease outcome: some authors suggested that higher viraemia levels in the early months after LT accelerate progression of liver disease; others showed a significant correlation between liver fibrosis and higher viraemia levels later on during follow-up. Thus, the current challenge is a better understanding of HCV infection dynamics in LT patients to optimize the management of hepatitis C recurrence by a proper timing and tailoring of antiviral therapy in the single patient. In this study, we investigated the relations between HCV-RNA kinetics during the first year after LT and the severity of the outcome of recurrent hepatitis C and 5-year graft survival.
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