Hepatitis C virus genotypes in liver transplant recipients - Impact on posttransplant recurrence, infections, response to interferon-alpha therapy and outcome

Background. End-stage liver disease due to hepatitis C virus (HCV) is the most common indication for liver transplantation in U.S. veterans. We investigated the influence of HCV genotypes on the incidence and timing of recurrent HCV hepatitis, survival, infectious morbidity, and response to interferon-alpha therapy in this unique patient population. Methods. HCV genotype was determined by direct sequencing of the NS5 region of HCV with type-specific primers. Results. Genotype la (66%, 32/47) was the predominant genotype. Type Ib was found in 25% (12/47) of patients and type 2b was found in 9% (4/41), Histopathologically recurrent HCV hepatitis developed in 53% (25/47) of the patients after transplantation. This group included 45% (14/31) of the patients with type la, 67% (8/12) of the patients with type Ib, and 25% (1/4) of the patients with type 2b (P>0.5). The time to recurrence and the severity of HCV recurrence as defined by aminotransferase levels or Knodell scores were not different among the three genotypes. There was a trend toward a higher incidence of major infections in patients with type Ib (75%) versus type la (48%) and type 2b (50%) (P=0.11). The response to interferon-alpha therapy did not differ significantly among the genotypes, Mortality at 5 years was 16% (5/31) in patients with genotype la, 42% (5/12) in patients with genotype Ib, and 50% (2/4) in patients with genotype 2b (P=0.06), Conclusions. The incidence, time to recurrence, and response to interferon-alpha therapy did not differ between the various genotypes in our liver transplant recipients. However, there was a trend toward higher infectious morbidity and overall mortality in patients with genotype Ib after transplantation.