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Immunopathogenesis and Outcomes of Recurrent Hepatitis C

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Liver Immunology

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Abstract

In the Western world, hepatitis C virus (HCV)-related end-stage liver disease is the leading indication for liver transplantation (LT). Based on the presence of HCV RNA in the serum, recurrence is immediate and universal, with nearly all patients developing some evidence of histological recurrence. (Acute hepatitis occurs in 60–80% at a median of 4–6 mo post transplantation and chronic hepatitis in 80–100% by 1–4 yr [1–3]. Reports indicate that 20 to 40% of recipients with recurrent HCV disease progress to allograft cirrhosis within 5 yr compared with less than 5% of nontransplant chronic HCV patients; thus, the natural history of recurrent HCV is accelerated compared with the nontransplant setting (4–5). Once cirrhosis develops in the transplant setting, two-thirds will develop decompensation (ascites, variceal hemorrhage, encephalopathy) within 3 yr (15–6). The development of decompensation is associated with a very poor outcome, with only about 10% surviving for 3 yr. Despite this accelerated course, approximately a third of patients demonstrate only minimal fibrosis after 5 yr of follow-up (7). The use of protocol liver biopsies is justified in patients transplanted for HCV based on the increasing probability of severe histological findings (stage 3 or 4) (8–9).

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Author information

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, University of Colorado at Denver and Health Sciences Center, Denver, CO

    James R. Burton Jr. MD

  2. Division of Gastroenterology and Hepatology, Hepatitis C Center and Integrated Program in Immunology, USA

    Lucy Golden-Mason PhD

  3. University of Colorado Health Sciences Center and National Jewish Hospital, Denver, CO

    Lucy Golden-Mason PhD

  4. Division of Gastroenterology and Hepatology, University of Colorado, Boulder, CO

    Hugo R. Rosen MD

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  1. James R. Burton Jr. MD
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  2. Lucy Golden-Mason PhD
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  3. Hugo R. Rosen MD
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Editors and Affiliations

  1. Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis School of Medicine, Davis, CA

    M. Eric Gershwin MD, FACP

  2. Departments of Medicine and Surgery Baylor Liver Health, Baylor College of Medicine, Houston, TX

    John M. Vierling MD, FACP

  3. Department of Gastroenterology, Hepatology, and Endocrinology, Medical School of Hannover, Hannover, Germany

    Michael P. Manns MD

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Burton, J.R., Golden-Mason, L., Rosen, H.R. (2007). Immunopathogenesis and Outcomes of Recurrent Hepatitis C. In: Gershwin, M.E., Vierling, J.M., Manns, M.P. (eds) Liver Immunology. Humana Press. https://doi.org/10.1007/978-1-59745-518-3_36

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  • DOI: https://doi.org/10.1007/978-1-59745-518-3_36

  • Publisher Name: Humana Press

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