Published online Mar 27, 2022. doi: 10.4254/wjh.v14.i3.602
Peer-review started: October 23, 2021
First decision: December 2, 2021
Revised: December 16, 2021
Accepted: February 15, 2022
Article in press: February 15, 2022
Published online: March 27, 2022
Processing time: 151 Days and 23 Hours
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.
Core Tip: Unexplained residual inflammation can be seen in a subset of liver transplant recipients successfully treated with direct-acting antiviral therapies; however, it does not seem to affect graft function. An extensive clinical and histopathologic workup should still be performed to exclude other potentially treatable conditions.