Source Dept. of Internal Medicine II (Gastroenterology and Hepatology), Medical University of Innsbruck, Austria. Ivo.Graziadei@i-med.ac.at.

There have been few studies of detailed viral kinetics following liver transplantation (LT) and conflicting data have been reported on viral load and severity of recurrent hepatitis C virus (HCV) disease. This long-term study aimed to examine (1) the impact of HCV RNA levels at specific points in time within the first year and (2) the influence of IL28B genotype on patient outcome and severity of recurrent HCV disease. Viral load was measured at week 2, 4, 12, 24 and 48 following LT and recipient / donor IL28B genotypes of 164 patients were determined. Cox-regression analysis showed that viral load at week 2 was an independent negative predictor of recipient outcome. A week 2 viral load of = 6.0 log(10) IU/mL was significantly associated with reduced patient survival. After a mean follow-up of 6.5 years 21 patients (12.2%) developed either a cholestatic type of HCV recurrence and/or rapid progression to cirrhosis within one year. Multivariate binary regression analysis showed that HCV viremia at week 2 and a non C/C recipient IL28B genotype were independent risk factors for cholestatic recurrent hepatitis C. No predictive factors could be found for the occurrence of recurrent liver cirrhosis at 5- and 10 years following LT. Our study shows that HCV RNA levels at week 2 and recipient IL28B genotype are independent, statistically significant risk factors for post-LT cholestatic hepatitis C emphasizing the importance of viral load monitoring and of IL28B genotyping to identify HCV recipients at risk for severe hepatitis C recurrence.