Article first published online: 23 DEC 2004
Copyright © 2004 American Association for the Study of Liver Diseases
Volume 41, Issue 1, pages 72–81, January 2005
How to Cite
Weston, S. J., Leistikow, R. L., Reddy, K. R., Torres, M., Wertheimer, A. M., Lewinsohn, D. M., Chou, S., Davey, M. P., Corless, C., O'Farrelly, C., Nelson, D. R. and Rosen, H. R. (2005), Reconstitution of hepatitis C virus–specific T-cell–mediated immunity after liver transplantation. Hepatology, 41: 72–81. doi: 10.1002/hep.20507
Presented at the Plenary Session of the AASLD, Boston, MA, November 2002.
Conflict of interest: Nothing to report.
- Issue published online: 23 DEC 2004
- Article first published online: 23 DEC 2004
- Manuscript Accepted: 21 SEP 2004
- Manuscript Received: 26 MAY 2004
- VA Merit Review. Grant Number: RO1 DK60590
Hepatitis C virus (HCV)-related liver failure is the leading indication for liver transplantation worldwide. After transplantation, virological recurrence is the rule, but the spectrum of histological injury is wide, ranging from the development of allograft cirrhosis within a few years to minimal hepatitis despite long-term follow-up. The immunological correlates of this variable natural history are poorly understood. Here, we studied the kinetics of the cellular immune responses, viral replication, and allograft histology in 24 patients who had undergone liver transplantation for HCV-related liver failure. Using direct ex vivo methodologies (i.e., interferon-gamma ELISPOT and major histocompatibility complex class I–peptide tetrameric complexes), we found that patients who experienced viral eradication after antiviral therapy showed restoration of HCV-specific T-cell responses, whereas patients with progressive HCV recurrence that failed to respond to therapy showed declining frequencies of these viral-specific effector cells. The cytotoxic T lymphocytes that peripherally reconstituted after transplantation were clonotypically identical to those present within the recipient explant liver, defined at the level of the T-cell receptor beta chain (one epitope/one clone). Moreover, the subset of patients who spontaneously demonstrated minimal histologic recurrence had more vigorous CD4+ T-cell responses in the first 3 months, particularly targeting nonstructural proteins. We provide evidence that T-cell responses emerge after liver transplantation, and their presence correlates with improved histological and clinical outcomes. In conclusion, these results may help identify patients more likely to develop severe HCV recurrence and therefore benefit from current antiviral therapy, as well as provide a rationale for the future use of novel immunotherapeutic approaches. Supplementary material for this article can be found on the HEPATOLOGY website (http://interscience.wiley.com/jpages/0270-9139/suppmat/index.html). (HEPATOLOGY 2005;41:72–81.)