Ismail Bahaaeldeen, Benrajab Karim M, Bejarano Pablo, Ruiz Phillip, Sears Debbie, Tzakis Andreas, Zervos Xaralambos Bobby
Division of Digestive Diseases and Nutrition, University of Kentucky College of Medicine, Lexington, KY 40536, United States.
Department of Pathology, Cleveland Clinic Florida, Weston, FL 33331, United States.
World J Hepatol. 2022 Mar 27;14(3):602-611. doi: 10.4254/wjh.v14.i3.602.
Persistent inflammation on histology after successful hepatitis C (HCV) treatment has been reported. However, data regarding the long-term impact in liver transplant recipients is limited, particularly after using direct-acting antiviral (DAA) therapies.
To evaluate the impact of successful treatment with DAAs on histological changes and occult HCV and to describe the clinical course of residual inflammation in liver transplant recipients.
We conducted a case series of 13 chronic HCV infected liver transplant recipients successfully treated with DAAs between December 2013 and May 2014. All patients were treated for 24 wk and had non-detectable serum HCV RNA by the time of biopsy. Only patients with at least one liver biopsy at or after treatment were included. We examined liver biopsies for evidence of residual inflammation and the presence of intrahepatic HCV RNA.
Persistent inflammation was seen in 12/13 patients on end of treatment biopsy. Inflammation was still seen in the available five follow-up biopsies (range 38-48 wk after the end of treatment). Intrahepatic HCV RNA was undetectable in all biopsies. All patients had preserved graft function for a mean follow-up of 2.5 years, except one that developed chronic rejection.
After successful HCV treatment with DAAs, liver transplant recipients may have persistent inflammation on biopsy without evidence of intracellular RNA. The clinical outcome remained favorable in most patients. Further studies with a larger number and longer follow-up are needed to establish the implication of this finding on long-term graft function.
已有报道称丙型肝炎（HCV）成功治疗后组织学上存在持续性炎症。然而，关于其对肝移植受者长期影响的数据有限，尤其是在使用直接抗病毒药物（DAA）治疗后。
评估DAA成功治疗对组织学变化和隐匿性HCV的影响，并描述肝移植受者残余炎症的临床病程。
我们对2013年12月至2014年5月期间13例成功接受DAA治疗的慢性HCV感染肝移植受者进行了病例系列研究。所有患者均接受了24周的治疗，活检时血清HCV RNA检测不到。仅纳入治疗时或治疗后至少有一次肝活检的患者。我们检查肝活检以寻找残余炎症的证据和肝内HCV RNA的存在情况。
12/13例患者在治疗结束时的活检中可见持续性炎症。在可获得的5次随访活检中（治疗结束后38 - 48周）仍可见炎症。所有活检中均未检测到肝内HCV RNA。除1例发生慢性排斥反应外，所有患者平均随访2.5年期间移植肝功能均保持良好。
DAA成功治疗HCV后，肝移植受者活检时可能存在持续性炎症，但无细胞内RNA证据。大多数患者的临床结局仍然良好。需要进行更多数量和更长随访时间的进一步研究，以确定这一发现对长期移植肝功能的影响。
