Pathogenesis of hepatitis C virus recurrence in the liver allograft

Authors

  • Geoffrey W. McCaughan MD,

    Director, Corresponding author
    1. A.W. Morrow Gastroenterology and Liver Centre; Australian National Liver Transplant Unit; and Liver Immunobiology Laboratory, Centenary Research Institute for Cancer Research and Cell Biology, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
    • A.W. Morrow Gastroenterology & Liver Centre, Royal Prince Alfred Hospital, Missenden Rd, Camperdown NSW 2050, Australia. Telephone: 61-2-9515-8578; FAX: 61-2-9515-5182
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  • Amany Zekry

    1. A.W. Morrow Gastroenterology and Liver Centre; Australian National Liver Transplant Unit; and Liver Immunobiology Laboratory, Centenary Research Institute for Cancer Research and Cell Biology, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
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Abstract

  • 1Hepatitis C virus (HCV) infection in the allograft occurs in the setting of greater viral burden than in nontransplantation patients.
  • 2Infection of the allograft occurs early (within days and possibly during the intraoperative reperfusion phase).
  • 3Viral burden plateaus at 1 month posttransplantation and (in the absence of cholestatic HCV) peaks at the time of acute hepatitis (1 to 4 months).
  • 4Acute hepatitis is associated with immune cell infiltration and hepatocyte apoptosis.
  • 5Cholestatic HCV seems to be a disease of direct HCV cytopathic injury in the setting of extreme virus levels, an intrahepatic T helper subtype 2 cell (TH2)-like response, and lack of a specific HCV-directed response.
  • 6Chronic hepatitic HCV seems to behave at the molecular and/or cellular level in a similar fashion to the nontransplantation setting, with activation of TH1 inflammatory, profibrotic, and proapoptotic pathways. This process operates at a greater viral burden than pretransplantation and leads to more progressive disease.
  • 7More studies are required to examine and distinguish allograft rejection in the setting of HCV infection from HCV infection alone.

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