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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care
Minerva Anestesiologica 1998 January-February;64(1-2):29-33
Hepatitits C recurrence in orthotopic liver trans-plantation (OLT)
Germi M. R. 1, Pellicci R. 2, Testa R. 3, Ardizzone G. 4, Lemut F. 1, Pozzo A. 2, Siani C. 4
1 Università degli Studi - Genova, Istituto di Anestesiologia e Rianimazione;
2 Univeristà-Ospedale San Martino - Genova, Divisione di Chirurgia dei Trapianti d’Organo;
3 Università degli Studi - Genova, Cattedra di Gastroenterologia, DIMI;
4 Univeristà-Ospedale San Martino - Genova, VSAR, Centro Trapianti
Background. This study is a review of hepatitis C recurrence in patients undergoing an orthotopic liver transplantation (OLT); to verify how many patients HCV-positive before OLT confirm a persistent viremia after OLT and how many with viremia show hepatitis histological evidence.
Methods. Thirty consecutive patients, 24 males, median age 52.5 underwent OLT for posthepatitic C cirrhosis since January 1993 in the “Transplantation Center” of Genoa. Serology included anti-HCV search, HCV-RNA and HBV-DNA determinations, biopses were performed in the transplanted liver within the month after operation, subsequently at every hepatic enzymes increase.
Results. Twenty-one patients are currently alive, median follow-up of 14.5 months. Before OLT anti-HCV antibodies search was positive in all the patients while the HCV-RNA by PCR resulted positive in 17 and negative in 4. Before OLT the HBV-DNA in patients with associated hepatitis B was negative. After OLT 5 patients, of the 17 HCV-RNA positive before OLT, have turned negative then all became again positive from 6 to 12 months later; 2 of the 4 patients HCV-RNA negative before OLT have turned positive, and remained still negative two with hepatitis C associated with hepatitis B. Although viral replication was present in 95% of the patients, clinical and histological evidence of recurrence was ascertained only in 29%.
Conclusions. It should be noted that the hepatitis histological picture doesn’t correspond to a severe worsening of clinical conditions, an evolution justifying transplantation. The long-term results of this therapeutic choice are still uncertain due to the high incidence of recurrences.