Professor Medicine, Nephrology
Mount Sinai School of Medicine
Evaluation of Genetic and Immune Markers to Predict HCV Recurrence after Liver Transplantation
Allograft failure secondary to recurrence of HCV is most common cause of death and re-transplantation in recipients with HCV. Serologic recurrence of HCV after transplantation is virtually universal while histologic recurrence is observed in 30-70% within 1 yr, and only 10-30% will develop allograft cirrhosis within 5 yrs. Many factors related to the host, donor, virus, and immunosuppression influence the natural history of recurrent HCV. Despite the presence of multiple contributing factors in many patients, only some develop recurrence of HCV, suggesting that a combination of several factors may be more detrimental, or that some individuals are more susceptible. Some maintain mild to moderate liver damage while others advance rapidly to end stage liver disease and graft failure. Our proposal is based on the following two hypothesis's: (1) The susceptibility to recurrence of HCV is modified by inherited genetic polymorphisms that modify the immune response and/or alter the grafts response to injury; (2) Recurrence of HCV can be predicted based on distinct intragraft gene expression patterns identified in the liver at the time of transplantation.