Retransplantation in hepatitis B--a multicenter experience.

Hepatitis B has become one of the most challenging diseases in liver transplantation. Infection of the allograft with subsequent graft failure is common and may prompt consideration of repeat liver transplantation. The aims of this study were to examine the experience in the United States with retransplantation in hepatitis B patients with recurrent disease as well as for other reasons. Questionnaires were mailed to adult liver transplant centers in the United States, requesting information on retransplantation in HBV patients. Responses were received from 71% of the centers. Thirty-eight patients were retransplanted, 20 for recurrent HBV and 18 for other reasons. The survival rate following retransplantation for HBV was poor. Nine patients (55%) died within 60 days. Eleven patients survived 60 days or longer, though eight died at a mean of 4.1 +/- 2 months, one required a third transplant for recurrent HBV infection at 4 months, and one died at 35 months. Only a single (5%) long-term survivor exists. Recurrent histologic disease occurred earlier in the second transplant at 2.8 +/- 2.9 months versus 6.1 +/- 5.2 months in the first allograft, though this difference did not reach statistical significance (P = .058). Patients transplanted for other reasons (primary non-function [9], hepatic artery thrombosis [6], persistent rejection [2], and a Pseudomonas graft infection [1]) had a better survival rate. Four patients survived less than 60 days. Of the 14 surviving longer than 60 days, 11 patients are alive at a mean of 21.2 +/- 14.8 months. Retransplantation for recurrent HBV appears to be contraindicated due to a high mortality. Retransplantation in HBV patients with graft failure due to other causes, however, should be considered, since over 60% of these patients appear to have good long-term survival. Additional studies examining risk factors for recurrent disease should be considered.

Hepatitis C in liver allografts.

Recurrent or intercurrent hepatitis C represents significant problems in patients with liver transplants and must be differentiated from hepatic allograft rejection and other conditions affecting allografts. Often, the currently available anti-hepatitis C virus (HCV) tests are not helpful in the differential diagnosis, because preexisting anti-HCV may persist after transplantation or its development may be delayed. We determined the presence of HCV RNA by the reverse double polymerase chain reaction in biopsy specimens of liver allografts from nine patients with acute or chronic hepatitis of uncertain origin and from three patients with cellular allograft rejection. The NS3 region sequences of HCV were detected in seven of nine liver allograft biopsy specimens 6 weeks to 20 months after transplantation. Hepatitis C virus RNA was not detected in two patients. One of these patients was anti-HCV positive, showing mild acute hepatitis 5 weeks after transplantation. Anti-HCV was present in three patients with detectable HCV RNA in the liver but was absent from four other patients with HCV RNA. These findings suggest that HCV is a major cause of acute and chronic hepatitis following liver transplantation, that detection of HCV RNA by polymerase chain reaction in the liver biopsy specimen represents a reliable method for the diagnosis of hepatitis C in liver allografts, and that in some patients HCV may be acquired during transplantation while in others it may represent a recurrent infection.

Detection, localization, and quantitation of HIV-associated antigens in intestinal biopsies from patients with HIV.

This study determined the prevalence, cellular localization, and content of human immunodeficiency virus (HIV)-associated antigens in intestinal mucosa from HIV-infected subjects. Studies were performed in 168 subjects with gastrointestinal, nutritional, or proctologic complaints, and HIV-seronegative controls. The polymerase chain-reaction technique, which detects viral DNA, was used in 20 subjects and was positive in 70%. In situ hybridization studies, using RNA probes, were employed in 48 cases and were positive in 31%. Immunohistologic studies using monoclonal antibodies to HIV p24 antigen were employed in 73 cases and were positive in 67%. Quantitative ELISA assays for tissue p24 content were performed in 168 cases and was positive in 68%. Evidence of HIV was found throughout the intestine and in different disease stages. The quantitative ELISA studies correlated significantly with in situ hybridization, implying a possible association between the presence of viral RNA and protein expression. The authors conclude that HIV is present in intestinal mucosa from most, if not all HIV-infected subjects. The relationship to intestinal disease currently is unclear.