title: HCV-related fibrosis progression following liver transplantation: increase in recent years.
abstract: OBJECTIVE
  The natural history and predictors of HCV-related disease severity post-transplantation are uncertain. The aims of this study were to define the natural history of post-transplantation HCV infection by assessing the rate of fibrosis progression, to determine if the post-transplantation natural history differs from that observed pre-transplantation, and to identify predictors of post-transplantation disease progression.
  
  
  METHODS
  Post-transplantation biopsies (mean: 3+/-1.6/patient) from 284 patients were scored according to histologic stage, using the method of Desmet et al. Change in fibrosis score (fibrosis progression/year) post-transplantation was used as the primary outcome. Predictors analyzed included viral factors (genotype and viral load at transplantation), patient demographics, year of transplantation, country of transplantation, pre-transplantation fibrosis progression, immunosuppression and laboratory data.
  
  
  RESULTS
  There was a linear association between change in fibrosis score and time from transplantation, with a median rate of fibrosis progression per year of 0.3 (0.004-2.19/year). Using parametric time-to-event analysis, the expected median duration to cirrhosis was 10 years. The rate of post-transplantation fibrosis progression was significantly higher than pre-transplantation (0.2/year (0.09-0.8) p<0.0001), and higher in Spanish than US centers (0.48 (0.01-2.19) vs 0.28 (0.004-2.08); p=0.09) despite similar progression rates prior to transplantation. Variables independently associated with post-transplantation progression included year of transplantation (p=0.0001), race (p=0.02), number of methyl-prednisolone boluses (p=0.03), and HCV RNA levels at transplantation (p=0.01).
  
  
  CONCLUSIONS
  HCV-related disease progression is accelerated in immunocompromised compared to immunocompetent patients, with a progressive increase in patients who have recently undergone liver transplantation. Changes in patient management post-transplantation over time and between transplant centers may account for the increase in fibrosis progression observed in recent years.
authors.affiliation: Department of Medicine, Veterans Administration Medical Center/University of California, San Francisco/Liver Center, 94121, USA.
authors.forename: M
authors.initials: M
authors.lastname: Berenguer
authors.forename: L
authors.initials: L
authors.lastname: Ferrell
authors.forename: J
authors.initials: J
authors.lastname: Watson
authors.forename: M
authors.initials: M
authors.lastname: Prieto
authors.forename: M
authors.initials: M
authors.lastname: Kim
authors.forename: M
authors.initials: M
authors.lastname: Rayón
authors.forename: J
authors.initials: J
authors.lastname: Córdoba
authors.forename: A
authors.initials: A
authors.lastname: Herola
authors.forename: N
authors.initials: N
authors.lastname: Ascher
authors.forename: J
authors.initials: J
authors.lastname: Mir
authors.forename: J
authors.initials: J
authors.lastname: Berenguer
authors.forename: T L
authors.initials: TL
authors.lastname: Wright
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D016174:Hepacivirus / Q000302:isolation & purification*; D006526:Hepatitis C / Q000150:complications* / Q000821:virology; D006801:Humans; D007165:Immunosuppression Therapy; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000209:etiology / Q000601:surgery* / Q000821:virology*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D013997:Time Factors