Determinants of progression to
cirrhosis in hepatitis C virus (HCV)
infection have been well described in the immunocompetent population but remain poorly defined in
liver transplant (LT) recipients. This cohort study determines the factors contributing to the development of
fibrosis and its rate of progression in the allograft. Predictive factors analyzed include: demographics, host and donor factors, surgery-related variables (cold and
warm ischemia time), rejection episodes,
cytomegalovirus infection (CMV), and immunosuppression. Over 12 years, 842 adult LTs were performed at our institution; 358 for the indication of HCV. A total of 264 patients underwent protocol liver biopsies at month 4 and yearly after LT. Using the modified Knodell system of Ishak for staging
fibrosis, the median
fibrosis progression rate was .8 units/year (P < .001). Rapid
fibrosis progression (> .8 units/year) was best identified by liver histology performed at 1 year. Donor age > 55 years was associated with rapid
fibrosis progression and development of
cirrhosis (P < .001). In contrast, donor age < 35 years was associated with slower progression of
fibrosis (P = .003). Risk factors for graft loss due to recurrent HCV included recipient age > 35 years (P = .01), donor age > 55 years (P = .005), and use of female donor allografts (P = .03). In conclusion,
fibrosis progression in HCV-infected LT recipients occurs at a rate of .8 units/year. Increased donor age has a major impact on
disease progression, graft failure, and patient survival. A liver biopsy performed at 1 year posttransplant can help identify those patients more likely to develop progressive disease and may allow better targeting of
antiviral therapy.