Clinical research on the mechanism of hepatitis C recurrence and its management following liver transplantation for hepatitis C liver cirrhosis

丙肝肝硬化活体肝移植术后病毒学复发是不可避免的。再加上移植后3年组织学复发明显，超过80%的病例，显然有效的治疗和/或有效的预防是必要的。在京都大学医院对F1及以上丙肝复发受者的分析显示：女性受者、男性供者、术前干扰素治疗、非小移植物。然而，即使没有危险因素的受者，复发率也达到80%左右，因此，如果不需要治疗，也不能归类为群体。名古屋大学医院的进一步研究表明：移植后病毒生长的程度不能通过移植前病毒载量或移植后立即病毒载量来预测。病毒载量（移植前、移植后立即、移植后1个月）不能预测组织学上的复发。虽然“病毒载量越低，抗病毒效果越好”，但移植后立即使用干扰素有激活免疫系统导致排斥反应的风险。我们的数据表明，一些病例在没有肝功能检测升高的情况下出现组织学排斥反应，因此，当我们考虑移植后立即进行抗病毒治疗时，肝活检以排除排斥反应是必不可少的。本研究有助于肝移植术后丙肝复发的管理和治疗。今后，有必要继续研究无类固醇免疫抑制或病毒清除治疗移植后病毒超调的方法，以期减轻病毒学复发的程度。

Virological recurrence after living-donor liver transplantation for Hep C liver cirrhosis is inevitable. Together with the fact that histological recurrence is evident with over 80% cases at 3 years after transplantation, it is obvious that effective treatment and/or effective prophylaxis are necessary.The analysis of recipients with Hep C recurrence (F1 and over) at Kyoto University Hospital revealed risk factors as follows : female recipient, male donor, preoperative interferon therapy, non-small graft. However, even with the recipients without risk factors, the recurrence rate reaches around 80%, therefore, they cannot be classified as group without necessity of treatment.Further investigation at Nagoya University Hospital showed : The extent of post-transplant viral growth is not predictable by the pre-transplant viral load or immediate post-transplant viral load. Viral load (pre-transplant, immediate post-transplant, 1 month after transplant) does not forecast histological recurrence.It is believed that "lower the viral load, greater the effect of anti-virals," however, the usage of interferon immediate after transplantation is fraught with risk of activation of immune system leading to rejection. Our data suggests that some cases encounter histological rejection in the absence of elevated liver function tests, therefore liver biopsy in order to exclude rejection in indispensable when we consider antiviral therapy immediately after transplantation.This research contributes to the management and treatment of Hep C recurrence after liver transplantation. Hereafter, continuing research is necessary regarding steroid-free immunosuppression or virus clearing therapy for viral overshoot after transplantation expecting the mitigation of magnitude of virological recurrence.