Clinicopathological features of hepatitis C virus disease after living donor liver transplantation: relationship with in situ hybridisation data - Introduction

A Special Author Introduction
Pathology
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By Yuichi Masuda

End-stage liver disease secondary to hepatitis C virus (HCV) infection is now a leading indication for liver transplantation. In this setting, virologic recurrence is almost universal, and recurrent hepatitis (RHC) occurs in a majority of post-transplant recipients.

RHC is often difficult to distinguish histologically from acute cellular rejection (ACR). This has important implications because increased immunosuppression against ACR potentially leads to severe form of RHC. As to the therapy for RHC, antiviral treatments with interferon (IFN) are the options to eradicate HCV. The response to IFN-based treatment varies among patients, and the parameters to predict this treatment response have been extensively studied.

We employed a non-isotopic in situ hybridization (ISH) technique to demonstrate the HCV genome (G) and replicate-intermediate (RI) within liver biopsy specimens taken from recipients after living donor liver transplantation for HCV disease, and investigated HCV-RNA expression as a histological marker for discrimination between RHC and ACR. Our results showed that ISH data for HCV in hepatic allografts are unable to differentiate RHC from ACR, however, reinforced that the treatments for ACR must be done with caution as viral replication is sustained during the episode of ACR.

Our study also showed that the extent of ISH positive cells, particularly RI positive cells, was predictive of response to IFN-based treatment. This indicated that clearance of HCV could be delayed in post-liver transplant patients with occurring increased viral replication because RI positive cells represent cells with viral replication.

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This article was originally published in Pathology, to read more research in this field please visit: www.rcpa-pathologyjournal.com