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Liver transplantation for patient with pretransplant undetectable hepatitis C RNA: can eradication of virus guarantee superior outcome?

Undetectable Hepatitis C RNA: Can Eradication of Virus Guarantee Superior Outcome? Suppressing hepatitis C virus (HCV) before and after liver transplantation (LT) should be a key to prevent clinically significant recurrence (1Y3). Occult HCV infection has been described as the presence of detectable HCV RNA in the liver or peripheral blood mononuclear cells with undetectable plasma HCV RNA by PCR assays (4). In that situation, even though HCV RNA seemed to disappear from serum, it would be possible that HCV replicates significantly under posttransplant immunosuppression, leading to clinically significant HCV recurrence. There is a paucity of literature focusing on this population. From 2005 to 2012, all LT patients with HCV at our institution were retrospectively evaluated. Exclusion criteria were as follows: no clinical information for pretransplant HCV RNA level, HCV antibody negative despite a clinical history associated with HCV infection, early mortality (within 30 days after LT), and patients without post-LT biopsy or measurement of HCV RNA. Our standard maintenance immunosuppression regimen consisted of tacrolimus, mycophenolate mofetil, and steroids. Patients also received induction immunosuppression with rabbit anti-thymocyte globulin (0.5Y1.0 mg/kg, postoperative day 1, 3, and 5) or basiliximab (20 mg, postoperative day 0 and 4) whereas some patients were given no induction agents, at the surgeon’s discretion. HCV RNA PCR was performed by the Bayer Verant HCV branched DNA assay version 3.0 (the lower limit of detection was 615 IU/mL) or by Roche COBAS Ampliprep and COBAS TaqMan HCV test (the lower limit of detection was 43 IU/mL). Protocol liver biopsy was