New Insights in Recurrent HCV Infection after Liver Transplantation

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

Load. HCV infection of the allograft is believed to be an extremely dynamic process. HCV virus binds to the new allograft at the time of reperfusion, and viral replication occurs within hours after LT. The impact of recipients' viral load on HCV recurrence following LT is still uncertain, but a clear understanding of HCV kinetics after LT will contribute to the development of strategies to prevent HCV infection of the allograft. An earlier study, which analyzed HCV kinetics during and immediately after LT, found a sharp decrease in HCV viral load during the anhepatic phase and immediately after graft reperfusion [3] . This decrease was presumably attributed to massive binding of HCV to the hepatocytes. In other words, reinfection is immediate after reperfusion. Powers et al. also reported that HCV RNA levels dropped with an average half-life of 0.8 hours during the anhepatic phase [14] . The authors also mentioned that viral loads then continued to drop up to 23 hours after implantation, and began to rise as soon as 15 hours after the anhepatic phase. Moreover, the viral load reached a plateau before rising, suggesting that a nonhepatic source supplied virions and balanced their intrinsic clearance. It was estimated that nonhepatic sources were at most responsible for 4% of total viral production and the remaining 96% occurred in the liver.