Acute rejection in HCV-infected liver transplant recipients: The great conundrum

Authors

  • James R. Burton Jr.,

    Corresponding author
    1. Division of Gastroenterology and Hepatology, Liver Transplantation Program and Hepatitis C Research Center, University of Colorado at Denver and Health Sciences Center, Denver, CO
    • University of Colorado Health Sciences Center, Division of Gastroenterology and Hepatology, 4200 East Ninth Avenue, B154, Denver, CO 80262
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    • Telephone: 303-372-6823; FAX: 303-372-8868

  • Hugo R. Rosen

    1. Division of Gastroenterology and Hepatology, Liver Transplantation Program and Hepatitis C Research Center, University of Colorado at Denver and Health Sciences Center, Denver, CO
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Abstract

Key Concepts:

  • 1In hepatitis C virus (HCV)-infected patients, treatment of acute rejection is associated with worse outcomes (increased risk of allograft cirrhosis and mortality).
  • 2Whether patients with HCV are at higher risk for rejection remains controversial.
  • 3The mechanisms mediating acute rejection and recurrence of HCV are distinct, and as such, it should be possible to develop techniques based on these molecular differences that are diagnostically useful.
  • 4Liver biopsy is considered the gold-standard for diagnosing acute rejection and recurrent HCV; however, given histopathological similarities between the two conditions, discrimination can be extremely difficult.
  • 5At the present time, there are no reliable, noninvasive tools available to distinguish between HCV recurrence alone and acute rejection plus HCV recurrence.
  • 6Mild rejection per se is not associated with graft loss and treatment of rejection with steroids and OKT3 is associated with worse outcome in HCV; thus, it seems logical that we should no longer treat mild rejection. Liver Transpl 12:S38–S47, 2006. © 2006 AASLD.

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