Morphologic Features of Hepatitis C Recurrence in Patients After Orthotopic Liver Transplantation-Preliminary Analysis of our Case Observations B. Ziarkiewicz-Wróblewska, B. Górnicka, U. Oldakowska-Jedynak, M. Bogdan ´ ska, T. Wróblewski, M. Morton, J. Zio ´ lkowski, L. Pa ˛ czek, M. Krawczyk, and A. Wasiutyn ´ ski ABSTRACT Introduction. Hepatitis C virus (HCV) recurrence is almost universal in patients after liver transplantation. The diagnosis of reinfection is more difficult than that of a primary process, as shown by our pathomorphologic analysis of cases of HCV recurrence. Material. During 5.5 years, 240 liver biopsies included 54 obtained from liver transplant recipients with primary HCV infections, among whom 26 (56.5%) had clinical signs and symptoms of hepatitis. Nineteen patients from this population underwent 30 liver biopsies. In addition, seven biopsies were performed in five patients without clinical signs of reinfection. Results. In 44.2% of patients with HCV recurrence and 15% without reinfection, the intensity of the primary process in the native livers was assessed as high. Reinfection was found in all patients with liver carcinoma and 67% with hepatocyte dysplasia. Histologic signs of infection were estimated as minimal (n = 4), mild (n = 19), or moderate (n = 4). In five patients with reinfections and one without recurrence, histologic manifestations of acute rejection were also observed. In conclusion, HCV was the indication for liver transplantation in 22.4% cases. Clinical manifestation of recurrence was found in 56.5% of the patients, who tended to be older than those without disease recurrence. Upon microscopy, lobular lesions predominated over the portal changes. Factors predisposing to HCV recurrence were coexistence of other liver disorders, a high intensity of the inflammatory process, hepatocyte dysplasia, and/or hepatocellular carcinoma in the native liver and acute rejection episodes. A MONG COMPLICATIONS observed in patients af- ter orthotopic liver transplantation, primary disease recurrence has become a more common problem. Recog- nition of recurrence is often more difficult than establishing the diagnosis of the primary liver disorder. Many factors influence the clinical and histologic findings, as well as the results of the laboratory tests: organ rejection, immunosup- pressive therapy, and opportunistic infections. Microscopic investigation of liver biopsy specimens is one of the basic diagnostic methods to confirm the diagnosis and assess actual organ status. However, pathomorphologic interpretation is often difficult, because the microscopic pic- ture is ambiguous, containing features characteristic of various pathologies. Therefore, histopathologic reports may contain a description of the pathologic changes, but without ultimate conclusion, or only a suggestion of a group disorder for further differential diagnosis. In such cases usually another biopsy is necessary to eliminate or confirm the pathology. Hepatitis C is characterized by a high relapse ratio; recurrence is observed in almost 90% of cases. 1 The course of hepatitis may be slow in the transplanted liver but in 10% to 30% patients it leads to cirrhosis within 5 years. From the Department of Pathology (B.Z.-W., B.G., M.B., M.M., A.W.), the Transplantation Institute, Department of Immunology, Transplantology and Internal Diseases, (U.O.-J., J.Z., L.P.), and the Department of General, Transplant and Liver Surgery (T.W., M.K.), Warsaw Medical University, Warsaw, Poland. Address reprint requests to Bogna Ziarkiewicz-Wróblewska, Department of Pathology, Warsaw Medical University, ul. Pawin ´- skiego 7, 02-106 Warsaw, Poland. E-mail: wroblewskabogna@ tlen.pl 0041-1345/06/$–see front matter © 2006 by Elsevier Inc. All rights reserved. doi:10.1016/j.transproceed.2005.12.018 360 Park Avenue South, New York, NY 10010-1710 226 Transplantation Proceedings, 38, 226 –230 (2006)