RT Journal Article
SR Electronic
T1 Immunohistochemical assessment of hepatitis C virus antigen in cholestatic hepatitis after liver transplantation
JF Journal of Clinical Pathology
JO J Clin Pathol
FD BMJ Publishing Group Ltd and Association of Clinical Pathologists
SP 174
OP 178
DO 10.1136/jcp.2005.028126
VO 59
IS 2
A1 F Fenwick
A1 M F Bassendine
A1 K Agarwal
A1 D Bevitt
A1 W Pumeechockchai
A1 A D Burt
A1 G L Toms
YR 2006
UL http://jcp.bmj.com/content/59/2/174.abstract
AB Background: Patients with common variable immunodeficiency may exhibit rapidly progressive hepatitis when infected with hepatitis C virus (HCV), leading to cirrhosis and liver failure. Liver transplantation in these patients may result in a cholestatic form of HCV reinfection with exceptionally high virus loads. Aims: To report an immunohistochemical investigation of the pretransplant and post-transplant liver of one such patient. Methods/Results: On immunohistochemical staining of frozen sections with anti-HCV core monoclonal antibody or fluorescein labelled human polyclonal anti-HCV IgG, no HCV antigens were demonstrated in the native cirrhotic liver removed at transplant, despite a viral load of 106.4 genomes/g. The transplanted liver, collected six weeks post-transplant, exhibited cholestatic recurrent hepatitis, had an HCV virus load of 1010 genomes/g of liver, and revealed HCV antigen in the cytoplasm of most hepatocytes, with a pronounced periportal distribution. No virus antigen was demonstrable in other cell types. The core antigen was also detected in paraffin wax embedded, formaldehyde fixed tissue of this liver after high temperature antigen retrieval, but not in the native cirrhotic liver or a selection of HCV positive livers collected pretransplant from immunocompetent patients. Attempts to delineate the distribution of E1, NS3, and NS4 antigens were unsuccessful because monoclonal antibodies to these antigens produced “false positive” staining of foci of hepatocytes in the post-transplant livers of HCV seronegative patients with cholestasis. Conclusion: This case provided an opportunity to study the natural development of HCV during acute infection in the absence of an immune response, and may help to elucidate the pathogenesis of HCV recurrence in liver allografts.