The Effect of Carriage of Apolipoprotein E Gene on Recurrence of HCV after Liver Transplantation

Abstract

Hepatitis C-related chronic liver disease is the main indication for liver transplantation in many centers. Viral RNA remains after transplantation in almost 100% of the patients. Recent reports showed a graft hepatitis rate of about 90% (Loinaz et al., 2001). Graft and patient survival is reduced in liver transplantation recipients with recurrent hepatitis C virus infection compared with hepatitis C virus-negative recipients. The natural history of chronic hepatitis C is accelerated after liver transplantation compared with non transplantation chronic hepatitis C; 20% to 40% of patients progress to allograft cirrhosis within 5 years, compared with less than 5% of non transplantation patients. The rate of fibrosis progression is not uniform and may change over time. The rate of progression from cirrhosis to decompensation is accelerated after liver transplantation (Gane, 2003). The hepatitis C virus associates with serum lipoproteins, including those containing apolipoprotein E (apoE) and apolipoprotein B (apoB), and may enter cells via the low-density lipoprotein receptor (LDLR) (Wozniak et al., 2002). It has been recently shown that ApoE4 seems to be protective against chronic hepatitis C virus infection and retards fibrosis progression (Kuhlmann et al., 2010). Studies reported that in immuno-competent patients the histological outcome of chronic hepatitis C is better among carriers of the apolipoprotein E (ApoE) 4 allele (Fabris et al., 2005). Aim of the study was to study the effect of the presence of Apolipoprotein E genotype in donor and/or recipient on the frequency of HCV recurrence following living donor liver transplantation (LDLT). This prospective cohort study was conducted on 50 patients with end stage liver disease secondary to HCV infection who were listed for LDLT in Ain Shams Specialized Hospital. Patients underwent LDLT surgery in the period between May 2012 to April 2013 and were followed up for at least one year for evidence of recurrence of HCV infection. All subjects enrolled in the study were subjected to detailed history taking, full physical examination and laboratory investigations. All included recipients and their donors underwent apolipoprotein genotyping by extracting DNA from whole blood samples by means of the extra-cell kit according to manufacturer's instructions.