Hepatitis C Recurs After Liver Transplant

Hepatitis C viral replication after liver transplantation occurs mainly in the implanted liver, according to a new study.

Hepatitis C is the number one reason for liver transplantation. However, the virus always recurs in the new liver. Using mathematical models, researchers at the Los Alamos National Laboratory (Los Alamos, NM, USA), led by Kimberly A. Powers and Ruy M. Ribeiro sought to quantify the liver reinfection dynamics of hepatitis C virus (HCV).

The researchers followed six HCV-infected patients who received cadaveric liver transplants. They collected blood samples before, during, and after transplantation to assess changing levels of HCV RNA. The data were introduced into a mathematical model (correcting for fluid balance), and the results were analyzed using linear regression. The researchers found that when the diseased liver was removed, virus levels dropped with an average half-life of 48 minutes. After the new liver was implanted, they found that virus levels continued to drop for up to 23 hours, then began to rise, doubling every two days. The study was published in the February 2006 issue of Liver Transplantation.

The authors estimate that non-hepatic sources can only account for 4% of total viral production, and the other 96% of it occurs in the liver. The findings also support the notion that HCV can replicate rapidly in the post-transplant immunosuppressed patient, leading the authors to suggest that early antiviral therapy may delay or prevent reinfection.

The rapid HCV RNA decline in the anhepatic phase, followed by the postoperative increase observed in several patients…suggests that the liver is the primary site of viral replication, with at most small contributions from extrahepatic sites,” the authors write. Continued work towards elucidating extrahepatic replication, the time-course of reinfection, the effects of immunosuppressive therapy, and the relationships among viremia, infection, and liver damage will be beneficial in optimizing treatment for HCV patients undergoing liver transplantation.



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Los Alamos National Laboratory