New Insights in Recurrent HCV Infection after Liver Transplantation

Hsu, Shih-Hsien; Yeh, Ming-Lun; Wang, Shen-Nien

The viral load can return to the pretransplant values within 4 days after transplantation and may be influenced by the usage of corticosteroids [5] . Acute hepatitis occurs between 2-5 months after transplant, and it is characterized by acute lobular hepatitis [4] . In the early reinfection stage, the graft injury occurs only after 3 weeks. Chronic hepatitis is established about 6-12 months after transplantation. The stage of chronic hepatitis is characterized by a decrease of viral load and a pattern of immune-mediated injury. A variant form of posttransplant HCV infection is cholestatic hepatitis C that occurs in <10% of patients, frequently associated with high viral load and immunosuppression. Usually, it occurs within 1-6 months after transplant and can progress to hepatic failure in 3-6 months [6] . This form is characterized by very high viral load, cellular ballooning, low inflammation, and a Th2 intrahepatic immunological response. These features suggest that the liver lesion is due to a direct cytopathic injury caused by HCV.