Department of Pathology and Laboratory Medicine, Calgary Laboratory Services, University of Calgary, Calgary, Alberta, Canada.
Department of Pathology and Laboratory Medicine, University of California San Francisco, San Francisco, California.
Clin Gastroenterol Hepatol. 2017 Aug;15(8):1279-1285. doi: 10.1016/j.cgh.2017.04.041. Epub 2017 May 10.
BACKGROUND & AIMS: Most patients, even those who have received a liver transplant, achieve a sustained virologic response (SVR) to therapy for hepatitis C virus (HCV) infection. Little is known about the histologic features of liver biopsy specimens collected after SVR, particularly in patients who have received a liver transplant. We aimed to better characterize the histologic features of allograft liver biopsy specimens from patients who achieved SVR to anti-HCV therapy after liver transplantation.
We performed a retrospective analysis of 170 allograft liver biopsy specimens from 36 patients who received a liver transplant for chronic HCV infection, had recurrent HCV infection after transplantation, and subsequently achieved SVR (collected from 1999 through 2015 at 4 medical centers). SVR was defined as an undetectable serum HCV RNA level 24 weeks after completion of HCV treatment. A total of 65 biopsy specimens were post-SVR (at least 1 post-SVR from each patient; some biopsy specimens were collected at later time points from a subset of patients). We performed polymerase chain reaction analysis for HCV RNA on a subset of the biopsy specimens (28 collected before SVR and 32 after SVR).
Of the 65 post-SVR biopsy specimens, 45 (69%) had histologic features of active HCV infection. Of the initial post-SVR biopsy specimens collected from each of the 36 patients, 32 (89%) showed these changes. For patients with more than 1 post-SVR biopsy specimen, 6 (46%) had no change in fibrosis between biopsies, and fibrosis worsened for 3 patients (23%) based on their most recent biopsy. The HCV RNA level was undetectable in 31 of the 32 biopsy specimens analyzed by polymerase chain reaction.
In a retrospective analysis of allograft liver biopsy specimens from patients who achieved SVR after a liver transplant for chronic HCV infection, histologic changes associated with active HCV were present in 69% and fibrosis continued to progress in 23%, despite the lack of detection of HCV RNA. Pathologists should be aware of patients' SVR status when analyzing liver biopsy specimens to avoid diagnoses of chronic HCV-associated hepatitis. Because of the persistent inflammatory activity and fibrosis after SVR, clinicians should continue to monitor patients carefully after SVR to anti-HCV therapy.
大多数患者，甚至包括那些接受过肝移植的患者，在接受丙型肝炎病毒（HCV）感染治疗后均能获得持续病毒学应答（SVR）。然而，对于 SVR 后收集的肝活检标本的组织学特征，尤其是在接受过肝移植的患者中，我们知之甚少。本研究旨在更好地描述 HCV 感染患者接受肝移植后获得 SVR 治疗后肝移植供体肝活检标本的组织学特征。
我们对 4 家医疗中心在 1999 年至 2015 年期间收集的 36 例因慢性 HCV 感染接受肝移植、移植后复发 HCV 感染、随后获得 SVR 的患者的 170 例肝移植供体肝活检标本进行了回顾性分析。SVR 定义为 HCV 治疗结束后 24 周时血清 HCV RNA 水平不可检测。共采集了 65 例 SVR 后肝活检标本（每位患者至少采集 1 例 SVR 后肝活检标本；部分患者在后续时间点采集了更多的肝活检标本）。我们对部分活检标本（28 例在 SVR 前采集，32 例在 SVR 后采集）进行了 HCV RNA 聚合酶链反应分析。
65 例 SVR 后肝活检标本中，45 例（69%）有 HCV 感染活动的组织学特征。36 例患者中，每位患者的初始 SVR 后肝活检标本中，32 例（89%）显示出这些变化。对于有多个 SVR 后肝活检标本的患者，6 例（46%）的纤维化在两次活检之间没有变化，3 例（23%）的纤维化根据最近的活检结果恶化。在通过聚合酶链反应分析的 32 例活检标本中，有 31 例 HCV RNA 水平不可检测。
在对因慢性 HCV 感染接受肝移植后获得 SVR 的患者的肝移植供体肝活检标本进行回顾性分析中，尽管 HCV RNA 检测不到，但在 69%的患者中存在与 HCV 活跃相关的组织学变化，23%的患者纤维化继续进展。病理学家在分析肝活检标本时应了解患者的 SVR 状态，以避免诊断为慢性 HCV 相关肝炎。由于 SVR 后仍存在持续的炎症活动和纤维化，临床医生应在 SVR 后继续密切监测患者抗 HCV 治疗的情况。
