Explanted liver inflammatory grade predicts fibrosis progression in hepatitis C recurrence.

Abstract

UNLABELLED:

Factors present prior to liver transplantation (LT) that predict fibrosis progression in recurrent hepatitis C infection (HCV) after LT would be important to identify. This study sought to determine if histologic grade of HCV in the explant predicts fibrosis progression in recurrent HCV. The clinical and histologic data of all 159 patients undergoing their first LT for HCV at our center from 1998 to 2001 were retrospectively reviewed with follow-up through June 2008. Twenty-five cases were excluded for: non-HCV-related graft loss <90 days (19), recidivism (4), or unavailable explant or follow-up biopsies (2). A single pathologist scored (Ishak) explants in a blinded fashion. Patients were grouped by explant inflammatory grade ≤ 4 (group1) and >4 (group 2). Prospectively scored liver biopsies (protocol months 1 and 4, annually, and as indicated clinically) were reviewed for development of advanced fibrosis (bridging or cirrhosis). Cox proportional hazard regression was used to analyze the association of explant grade, donor, viral and LT factors with progression to advanced fibrosis. The groups were well-matched for patient, viral, donor, and transplant factors. Five-year advanced fibrosis-free survival in group 1 versus group 2 was 63% versus 28%, P < 0.001. Explant grade >4 was associated with increased HCV-related graft loss at 1 (6% versus 3%) and 5 (36% versus 14%) years post-LT (P = 0.003). On univariate and multivariate Cox regression analysis, predictors of advanced fibrosis were explant grade >4 (hazard ratio [HR] = 3.3, 95% confidence interval [CI] = 1.9-5.6, P < 0.001) donor age >50 (HR = 3.3, 95% CI = 1.9-5.7, P < 0.001) and viral load at LT of >158,730 IU/mL (HR = 1.8, 95% CI = 1.05-3.1, P = 0.03).

CONCLUSION:

Explant histologic grade can identify patients requiring more aggressive monitoring and intervention for HCV recurrence post-LT.

• Authors: Marwan Ghabril, Rolland C Dickson, Murli Krishna, Victor Machicao, Jaime Aranda-Michel, Hugo Bonatti, Justin H Nguyen
• Journal: Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society (Liver Transpl) Vol. 17 Issue 6 Pg. 685-94 (Jun 2011) ISSN: 1527-6473 [Electronic] United States
• PMID: 21618689 (Publication Type: Journal Article)
• Copyright: Copyright © 2011 American Association for the Study of Liver Diseases.

Chemical References

• Antiviral Agents

Topics

• Adult
• Antiviral Agents (therapeutic use)
• Biopsy
• Disease Progression
• Female
• Follow-Up Studies
• Hepatitis C (drug therapy, pathology, surgery)
• Humans
• Immunosuppression Therapy
• Kaplan-Meier Estimate
• Liver (pathology)
• Liver Cirrhosis (diagnosis, pathology)
• Liver Transplantation
• Male
• Middle Aged
• Predictive Value of Tests
• Recurrence
• Regression Analysis
• Retrospective Studies
• Treatment Outcome