PREDICTORS OF EARLY RECURRENCE OF HEPATITIS C DISEASE AFTER LIVER TRANSPLANTATION

Abstract

Liver transplantation (LT) is the best curative option for patients with HCV related end stage liver disease and this is a leading indication for LT. Unfortunately post transplant HCV recurrence is almost universal, and it presents a challenging situation to both patients and transplant hepatologists alike. Patients who are wrestling post-transplant. surgical complications, medication related side effects and rejection episodes have to also worry about ongoing allograft injury secondary to HCV recurrence. In addition, physicians face the challenge of identifying candidates eligible for antiviral therapy, the ideal time to initiate therapy and find means to combat side effects of therapy, in this cohort of very sick patients. This study was conducted to assess the predictors of early recurrence of hepatitis C disease after liver transplantation. To fulfill the aim of this study, 59 patients transplanted due to HCV related end stage liver disease with histological evidence of recurrent hepatitis C disease after liver transplantation were included in this study.

The patients were divided into 2 groups: Group A: included 24 patients with early recurrent hepatitis C within the first 6 months of liver transplant. Group B: included 35 patients with recurrent hepatitis C after the first 6 months of liver transplant. Inclusion criteria: All patients after liver transplantation for HCV-related end-stage liver disease, with histological features of recurrent hepatitis C (defined as the presence of lobular and portal inflammation) in the graft in patients with detectable HCV RNA in serum by polymerase chain reaction (PCR). Exclusion criteria: 1. All other causes of histological injury including graft rejection, biliary or vascular complications. 2. All other etiologies of liver insult before transplantation except HCV. Results of the present work showed that CMV infection and history of rejection episodes were significantly higher in group A (patients with early recurrence of hepatitis C) than group B. However our data revealed that the type of immuno-suppressive drugs used have no statistically significant influence on early recurrence of hepatitis C disease after liver transplantation we found that patients suffered from early recurrence of hepatitis C had statistically significant higher trough level of calcineurin inhibitors ( TAC, cyclosporine) and received higher doses of TAC when compared to patients with late recurrence which made them good predictors for early recurrence of the disease. Here in the current work, it was also crucial to determine a cut off value for the trough level of Calcineurin inhibitors which can predict the early recurrence of hepatitis C after liver transplantation, so ROC curve was designed and the results showed that trough level >211 ng/ml for cyclosporine and >9.6 ng/ml for tacrolimus can predict the early recurrence of the disease As we agreed that the recurrence of hepatitis C after liver transplant is universal, it is very important to identify patients with high risk of early recurrence of the disease so that consideration can be taken in a timely fashion to use antiviral agents and/or decision to re-transplant. Therefore, there is a great need for biomarkers capable of accurately predicting HCV recurrence after LT.