Fragulidis G P, Cirocco R E, Weppler D, Berho M, Gillian G, Markou M, Viciana A, Esquenazi V, Nery J R, Miller J, Reddy K R, Tzakis A G
Department of Surgery, University of Miami School of Medicine, Florida 33136, USA.
Transplantation. 1998 Dec 15;66(11):1472-6. doi: 10.1097/00007890-199812150-00010.
Hepatitis C infection recurs after orthotopic liver transplantation for hepatitis C virus (HCV)-related end-stage liver disease. Overlapping histopathologic features may present difficulties in differentiating recurrent HCV in the allograft from other conditions, especially rejection.
In this study, we evaluated the presence of HCV-RNA by reverse transcriptase in situ polymerase chain reaction (RT in situ RCR) in hepatic tissue, after orthotopic liver transplantation for HCV-related liver disease. Further, detection of HCV-RNA was correlated with the serum HCV-RNA levels, histopathology, and clinical outcome.
Twenty-five patients were part of this study. Seventeen patients were transplanted for HCV cirrhosis and eight for an underlying disease other than HCV. None of the patients in the non-HCV group had in situ RT-PCR detection of HCV-RNA. Positive RT in situ PCR for HCV was found in 9 of 17 HCV patients, and the patients had a clinical course consistent with recurrent hepatitis C disease. Four of these nine patients had an initial histologic diagnosis of rejection. The other eight patients in the HCV group had negative RT in situ PCR, and none of them had a course compatible with recurrent HCV disease, although four patients were histologically diagnosed as having chronic C hepatitis. The mean HCV-RNA level (log/mL) in the patients who had in situ detection of HCV-RNA was 7.01+/-0.26. Although RT-PCR was negative in 8 of 17 HCV patients, the patients were serologically viremic and the mean HCV-RNA level was 6.05+/-0.33 (P=0.03).
Our findings indicate that the HCV in situ RT-PCR assay may be helpful in the differentiation of recurrent hepatitis C disease from rejection. This may further help in the adjustment of immunosuppression.
丙型肝炎病毒（HCV）相关终末期肝病患者原位肝移植后丙型肝炎感染会复发。重叠的组织病理学特征可能难以将移植肝中的复发性HCV与其他情况（尤其是排斥反应）区分开来。
在本研究中，我们对因HCV相关肝病接受原位肝移植后的肝组织进行逆转录原位聚合酶链反应（RT原位RCR），评估HCV-RNA的存在情况。此外，将HCV-RNA的检测结果与血清HCV-RNA水平、组织病理学和临床结局相关联。
25例患者参与了本研究。17例患者因HCV肝硬化接受移植，8例因HCV以外的基础疾病接受移植。非HCV组患者均未通过原位RT-PCR检测到HCV-RNA。17例HCV患者中有9例RT原位PCR检测HCV呈阳性，这些患者的临床病程与复发性丙型肝炎疾病一致。这9例患者中有4例最初的组织学诊断为排斥反应。HCV组的其他8例患者RT原位PCR检测为阴性，尽管其中4例患者组织学诊断为慢性丙型肝炎，但他们均无符合复发性HCV疾病的病程。原位检测到HCV-RNA的患者的平均HCV-RNA水平（log/mL）为7.01±0.26。虽然17例HCV患者中有8例RT-PCR检测为阴性，但这些患者血清学呈病毒血症，平均HCV-RNA水平为6.05±0.33（P=0.03）。
我们的研究结果表明，HCV原位RT-PCR检测可能有助于区分复发性丙型肝炎疾病与排斥反应。这可能进一步有助于调整免疫抑制。
