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Effects of immunosuppression and organ transplantation on the natural history and immunopathogenesis of hepatitis C virus infection


  • Editor’s introduction

    The role of the immune response in the pathogenesis of liver injury during hepatitis C viral infection remains to be clarified. In the immunologically normal host, liver injury is largely mediated by the host’s immune response. By contrast, McCaughan and Zekry review the available data, which suggest that, in the immunocompromised host, viral cytopathogenicity dominates the progression of liver disease. This observation demonstrates the acute need for improved antiviral therapies. The balance between immune suppression and the management of HCV infection in transplantation is precarious. Given the impact of acute rejection on disease progression and the possible links between HCV, stimulation of B-cell proliferation and PTLD, new strategies for the management of this infection remain critical.

    Jay A. Fishman, MD

    Editor, Basic Science

Correspondence to:Geoffrey W. McCaughan, MBBS, FRACP, PhD
The AW Morrow Gastroenterology and Liver Centre
Royal Prince Alfred Hospital and University of Sydney
Missenden Road
Camperdown 2050
Tel: +61Θ295155182
Fax: +61Θ295155182


The hepatitis C virus (HCV) is recognized as the leading cause for parenterally transmitted hepatitis. It is characterized by a high propensity to chronicity. Several efforts have been directed towards understanding the natural history of chronic HCV infection and the immunopathogenic pathways involved in mediating liver injury in the non-immunosuppressed and immunosuppressed states. In the non-immunosuppressed setting, liver damage seems to be largely immune mediated. In contrast, in the non-immunosuppressed state, there are several other factors that may modify the natural course of the infection and play a role in mediating liver injury. In this review we will address the natural history, virological and immunological aspects of HCV infection. Also, the role played by immunosuppression and organ transplantation in modifying the course of the infection and the pathogenesis of liver injury will be discussed.(Note)