Progression of liver fibrosis in patients with chronic hepatitis C after orthotopic liver transplantation.
BACKGROUND
Hepatitis C virus (HCV)-related cirrhosis is the leading indication for orthotopic liver transplantation (OLTx). HCV recurrence is universal after OLTx, with a highly variable course. This study aimed to find factors that affect progression of fibrosis in recurrent HCV.


METHODS
Fifty-eight HCV patients underwent OLTx at our center who were selected on the basis of available preOLTx serum or explanted liver sample and liver biopsy obtained at least 6 months postOLTx. All liver biopsies were performed when clinically indicated and were scored using the modified Hepatitis Activity Index (HAI). Primary immunosuppression consisted of tacrolimus and prednisone.


RESULTS
The group included 41 males (mean age 49.6 years). HCV genotype distribution was 1a, 31 (53%); 1b, 16 (28%), and others 11 (19%). The mean follow-up was 53.1 months. Patients with genotype 1a (n=31; mean 46.3 months) had significantly lower fibrosis-free survival analyzed by the presence of fibrosis stages 5 and 6 when compared with other genotypes (n=27; mean 60.1 months; P=0.0088, log rank test). Mean HAI scores were significantly higher in HCV genotype 1a, although there were no differences in survival between genotypes. Similarly, patients with cytomegalovirus (CMV) infection postOLTx (n=4) had a higher fibrosis progression rate compared with those without CMV (n=54) (mean fibrosis-free survival 29.0 vs. 53.0 months P=0.0004, log-rank test). Human leukocyte antigen matching and rate of acute rejection did not influence progression of fibrosis.


CONCLUSIONS
Patients with HCV genotype 1a and those developing CMV postOLTx have a higher rate of hepatic fibrosis progression after OLTx for HCV-related chronic liver disease.
Chopra
Kapil B
KB
Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
Demetris
Anthony J
AJ
Blakolmer
Karen
K
Dvorchik
Igor
I
Laskus
Tomasz
T
Wang
Lian-Fu
LF
Araya
Victor R
VR
Dodson
Forest
F
Fung
John J
JJ
Rakela
Jorge
J
Vargas
Hugo E
HE
D000328:Adult; D018450:Disease Progression; D018572:Disease-Free Survival; D005838:Genotype; D016174:Hepacivirus / Q000302:isolation & purification; D019698:Hepatitis C, Chronic / Q000601:surgery*; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D008103:Liver Cirrhosis / Q000503:physiopathology*; D016031:Liver Transplantation / Q000401:mortality / Q000473:pathology*; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors