New Insights in Recurrent HCV Infection after Liver Transplantation

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

Glucocorticoids. Glucocorticoids are often given as an induction protocol during LT, and low doses combined with other immunosuppressants are used as maintenance immunosuppression after operation. In case of acute rejection, recipients receive pulse methylprednisolone to reverse the rejection. There are convincing data that bolus doses of glucocorticoids given for rejection treatment have a negative impact on HCV recurrence. It is estimated that cumulative exposure to corticosteroids is associated with increased mortality, higher levels of HCV viremia, and more severe histological recurrence [34] . One recent study demonstrated that glucocorticosteroids specifically increased HCV entry by upregulating the cell entry factors occludin and scavenger receptor class B type I. The data suggested that the potential effects of high-dose glucocorticosteroids on HCV infection in vivo may be due to increased HCV dissemination [35] . Previous studies have indicated that the specific CD4 T cell response to HCV is important in viral clearance of acute HCV infection after liver transplantation. Moreover, plasmacytoid dendritic cells are capable of producing large amounts of IFN against HCV infection in this specific CD4 T cell response [36, 37] . Experimental data have shown that prednisolone suppressed the functions of plasmacytoid dendritic cells by promoting their apoptosis [38] . Thus, in a transplant setting, the consensus is that steroid avoidance or slow tapering of the dose is associated with reduced HCV recurrence [39, 40] , whereas boluses for treating acute rejection can increase the viral load [31] .