Recurrent hepatitis C virus hepatitis in liver transplant recipients receiving tacrolimus: Association with rejection and increased immunosuppression after transplantation

Background. Recurrent hepatitis C virus hepatitis is associated with significant morbidity and mortality after liver transplantation. However, the risk factors for clinical recurrence including the role of rejection and immunosuppression have nor been defined in patients receiving tacrolimus (FK506) as primary immunosuppression. Methods. Sixty-six consecutive adult liver transplant recipients receiving tacrolimus as primary immunosuppression were monitored; 31 of 66 underwent transplantation for end-stage liver disease caused by hepatitis C virus. Median follow-up for the patients in the study was 3 1/2 years. Recurrent hepatitis C virus hepatitis determined on histopathologic evaluation developed in 58% (18 of 31). A number of clinical variables including rejection and intensity of immunosuppression were assessed for patients with and without recurrence. Results. Rejection episodes preceding recurrence were documented in 72% (13 of 18) of patients with recurrence compared with 23% (3 of 13) in those without recurrence (p = 0.007). A total of 33% (5 of 15) of patients with no rejection experienced recurrence versus 83% (5 of 6) with one episode of rejection (p = 0.06) and 80% (8 of 10) with more than one episode of rejection (p = 0.04). The mean number of steroid boluses for the treatment of rejection was higher for patients with recurrence (2.3 versus 0.77, p = 0.01). Overall immunosuppression (as measured by steroid boluses, recycles, OKT3, and azathioprine) was significantly more intense for patients with recurrence (p = 0.013). Conclusions. Greater rejection concurrent with increased immunosuppression was associated with a higher recurrence of hepatitis C in liver transplant recipients.