Histological hepatitis occurs in the majority of hepatitis C virus (HCV)-infected liver transplant recipients. Its natural history is highly variable.
Prolonged follow-up has suggested that some patients with initial benign recurrence may develop a late-onset aggressive course.
In this study, physicians from Spain determined the incidence and factors associated with late-onset severe hepatitis C.
The team evaluated the histological outcome of 57 HCV type 1b-infected transplant recipients with initial benign recurrence.
They defined severe late-onset liver damage as progression to F3 or F4 after previous benign recurrence.
|Severe late-onset liver damage occurred in 35% of patients.|
The physicians found that severe late-onset liver damage occurred in 35% of patients.
They determined that 12 transplant recipients progressed to F3 and 8 progressed to F4.
The team identified baseline fibrosis stage and activity grade, female gender, alanine aminotransferase (ALT) level at 1 year, and baseline aspartate aminotransferase (AST) and ALT levels as factors influencing late-onset disease.
However, multivariate analysis found only fibrosis stage at baseline a significant factor.
Dr Marina Berenguer's team concluded, "Delayed HCV-related severe liver damage is not infrequent in transplant recipients with initial benign recurrence, occurring in approximately one third of them".
"The presence of some degree of fibrosis at baseline appears to predict this sudden change in the natural history of recurrent hepatitis C".
"Based on these findings, we recommend continuing protocol biopsies and evaluating potential antiviral therapy in transplant recipients with evidence of some fibrosis".