Hepatitis Recurrence Rapid After Transplant, Warn Experts

by John C. Martin
Article Date: 02-03-06



Experts are warning that hepatitis C (HCV) can return rather quickly
following a liver transplant. That's even after the transplant
itself helped significantly reduce viral levels. The findings are
reported in the February issue of the journal Liver Transplantation.1

The viral rebound, say the researchers from the Los Alamos National
Laboratory in New Mexico, can occur within a few days.

A Primary Transplant Cause
Hepatitis C is the primary reason for liver transplantation. Yet the
virus always recurs in the new liver, doctors have found.

In this study, chief investigators Kimberly Powers and Ruy Ribeiro
sought to use special mathematical calculations to determine the
odds, and quantity, of liver reinfection after a transplant.

For their research, the Los Alamos team in conjunction with the a
surgical team from Duke University Medical Center, followed six HCV-
infected patients who received livers from cadavers. The researchers
collected blood samples before, during and after transplantation to
evaluate blood levels of the virus in these patients. The
information was then plugged into the mathematical model used in the
study to calculate future varying viral loads following the
transplant procedures.

"In most patients, HCV RNA [genetic evidence of the virus' presence]
levels decreased rapidly during and after transplantation, and
subsequently began to increase, reaching above pre-transplant levels
in all but one patient, within a few days of the procedure," wrote
the medical research team.

Viral Rebound
They found that when the diseased liver was removed, viral load
dropped. But after the new liver was implanted, virus levels
continued to drop for up to 23 hours, then began to rise, doubling
every two days.

The investigators noted that in three patients, vial load plateaued
before rising, suggesting that some source other than the liver was
responsible for helping the virus maintain certain levels. However,
they were quick to add that these non-liver-based sources accounted
for only about four percent of total viral production. The rest
occurs directly in the liver.

The patterns of viral load decrease followed by increases are
consistent with previous study findings. The findings also suggest
that HCV can replicate (make copies of itself) rapidly in the post-
transplant patient taking immunosuppression therapy, typically given
to prevent liver rejection. This may mean that early antiviral
therapy may help delay or even prevent reinection, the study authors
wrote.

This study, the researchers pointed out, was limited by the small
number of patients, making it difficult to suggest that the findings
were similar to what would occur in the overall population of liver
transplant patients with hepatitis. The study also didn't take into
account the sources of viral replication, whether liver- or non-
liver-based.

"Nevertheless, the rapid HCV RNA decline … followed by the
postoperative increase observed in several patients … suggest that
the liver is the primary site of viral replication, with at most
small contributions from extrahepatic sites," Powers, Ribeiro, and
their colleagues concluded.

1. Powers KA, Riberio RM, Patel K et al. Kinetics of hepatitis C
virus reinfection after liver transplantation. Liver Transpl 2006
Jan 30;12(2):207-16 [Epub ahead of print].

John Martin is a long-time health journalist and an editor for
CuraScript. His credits include overseeing health news coverage for
the website of Fox Television's The Health Network, and articles for
the New York Post and other consumer and trade publications