Increasing serum levels of IgM anti-HCV are diagnostic of recurrent hepatitis C in liver transplant patients with ALT flares

被引:10
作者
Ciccorossi, P
Filipponi, F
Oliveri, F
Campani, D
Colombatto, P
Bonino, F
Campa, M
Maltinti, G
Mosca, F
Brunetto, MR
机构
[1] Azienda Osped Pisana, UO Gastroenterol & Epatol, I-56124 Pisa, Italy
[2] IRCCS, Osped Maggiore, Milano Policlin Univ, Milan, Italy
[3] Univ Pisa, Pisa, Italy
关键词
anti-HCV IgM; HCV-RNA; hepatitis C; liver transplantation; rejection;
D O I
10.1046/j.1365-2893.2003.00425.x
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Recurrent hepatitis and acute rejection share common features which make difficult for diagnosis in liver transplant hepatitis C virus (HCV) positive patients. We studied the usefulness of quantitative monitoring of HCV RNA and immunoglobulin (Ig)M anti-HCV in the differential diagnosis between recurrent hepatitis and acute rejection in 98 consecutive anti-HCV positive liver transplant patients. Aminotransferase levels, serum HCV RNA and IgM anti-HCV were measured at the time of transplantation and monthly thereafter. A liver biopsy (LB) was obtained when serum aminotransferase levels increased to twice or more than normal. During a mean follow-up of 16 months 86 aminotransferase flares were observed. Histology was compatible with recurrent hepatitis C in 44 cases and with acute rejection in 28, doubtful in 14. The fluctuations of HCV RNA serum levels were not significantly different in the three groups. Serum IgM anti-HCV levels increased (from negative to positive or with value variations greater than or equal to 0.18) in 36 of 44 cases with recurrent hepatitis C at the time of alanine aminotransferase (ALT) flare. IgM anti-HCV remained unchanged in all rejection cases (P < 0.001), but increased in 10 of 11 histologically doubtful cases that were diagnosed as hepatitis at the second LB. Increasing serum levels of IgM anti-HCV at the time of ALT flares are significantly associated with recurrent hepatitis C in liver transplant patients. The quantitative monitoring of IgM anti-HCV appears to be an additional diagnostic tool for distinguishing recurrent hepatitis C from acute graft rejection with a 100% specificity; 100% positive predictive value and 88.9% diagnostic accuracy.
引用
收藏
页码:168 / 173
页数:6
相关论文
共 25 条
[1]  
Aardema KL, 1999, MODERN PATHOL, V12, P1043
[2]   Hepatitis C after orthotopic liver transplantation [J].
Araya, V ;
Rakela, J ;
Wright, T .
GASTROENTEROLOGY, 1997, 112 (02) :575-582
[3]  
Berenguer M, 2001, J HEPATOL, V35, P666, DOI 10.1016/S0168-8278(01)00179-9
[4]   Early development of chronic active hepatitis in recurrent hepatitis C virus infection after liver transplantation:: association with treatment of rejection [J].
Berenguer, M ;
Prieto, M ;
Córdoba, J ;
Rayón, JM ;
Carrasco, D ;
Olaso, V ;
San-Juan, F ;
Gobernado, M ;
Mir, J ;
Berenguer, J .
JOURNAL OF HEPATOLOGY, 1998, 28 (05) :756-763
[5]   Anti-hepatitis C virus core IgM antibodies correlate with hepatitis C recurrence and its severity in liver transplant patients [J].
Bizollon, T ;
Ahmed, SNS ;
Guichard, S ;
Chevallier, P ;
Adham, M ;
Ducerf, C ;
Baulieux, J ;
Trepo, C .
GUT, 2000, 47 (05) :698-702
[6]   MONITORING THE NATURAL COURSE AND RESPONSE TO THERAPY OF CHRONIC HEPATITIS-B WITH AN AUTOMATED SEMIQUANTITATIVE ASSAY FOR IGM ANTI-HBC [J].
BRUNETTO, MR ;
CERENZIA, MT ;
OLIVERI, F ;
PIANTINO, P ;
RANDONE, A ;
CALVO, PL ;
MANZINI, P ;
ROCCA, G ;
GALLI, C ;
BONINO, F .
JOURNAL OF HEPATOLOGY, 1993, 19 (03) :431-436
[7]   Diagnostic value of anti-hepatitis C virus (HCV) core immunoglobulin M in recurrence of HCV infection after orthotopic liver transplantation [J].
Casino, C ;
Lilli, D ;
Rivanera, D ;
Comanducci, A ;
Rossi, M ;
Casciaro, G ;
Pecorella, I ;
Alfani, D ;
Mancini, C .
JOURNAL OF CLINICAL MICROBIOLOGY, 1999, 37 (08) :2726-2728
[8]   Quantitative analysis of IgM anti-HBc in chronic hepatitis B patients using a new ''gray-zone'' for the evaluation of ''borderline'' values [J].
Colloredo, G ;
Bellati, G ;
Leandro, G ;
Colombatto, P ;
Rho, A ;
Bissoli, F ;
Brunetto, MR ;
Angeli, G ;
Ideo, G ;
Bonino, F .
JOURNAL OF HEPATOLOGY, 1996, 25 (05) :644-648
[9]  
Crespo J, 1997, AM J GASTROENTEROL, V92, P1458
[10]   Cholestatic hepatitis after liver transplantation is associated with persistently high serum hepatitis C virus RNA levels [J].
Doughty, AL ;
Spencer, JD ;
Cossart, YE ;
McCaughan, GW .
LIVER TRANSPLANTATION AND SURGERY, 1998, 4 (01) :15-21