Rationale:
Recurrent HCV viremia following liver transplantation is nearly universal, with 80% to 100% of patients who are HCV RNA-positive after liver transplant developing histological evidence of chronic hepatitis C within one to four years. It is estimated that some 30% of patients with chronic hepatitis C develop recurrent cirrhosis within five years of transplantation. A smaller percentage develop severe acute recurrence of HCV with rapid graft loss. Severe recurrence is associated with higher pre-transplant viral load, cumulative post-transplant steroid dosage, and use of anti-rejection monoclonal antibodies. It is therefore of vital importance to accurately diagnose the cause of post-transplant elevation in serum aminotransferases prior to making treatment decisions. In this case, liver biopsy is indicated to differentiate between recurrent serum HCV and acute cellular rejection, which are treated in widely disparate manners.
References:
Carmiel-Haggai M, Fiel MI, Gaddipati HC, Abittan C, Hossain S, et al. Recurrent hepatitis C after retransplantation: Factors affecting graft and patient outcome. Liver Transplant. Dec 2005;11(12):1567-1573.
Chalasani N, Manzarbeitia C, Ferenci P, Vogel W, et al; Pegasys Transplant Study Group. Peginterferon alfa-2a for hepatitis C after liver transplantation: two randomized, controlled trials. Hepatology. Feb 2005;41(2):289-298.
Charlton M, Wiesner R. Natural history and management of hepatitis C infection after liver transplantation. Semin Liver Dis. 2004;24:79-88.