title: Retrospective analysis of the impact of immunosuppression on the course of recurrent hepatitis C after liver transplantation.
abstract: BACKGROUND
  In a substantial proportion of patients, recurrent hepatitis C after liver transplantation (OLT) rapidly progresses to graft cirrhosis. The role of different immunosuppressive schemes is not well evaluated.
  
  
  METHODS
  The clinical course of 130 patients with recurrent hepatitis C after OLT was retrospectively analyzed. Mean trough levels of calcineurin inhibitors and cumulative doses of the remaining immunosuppressants were calculated. The results were compared with liver function tests, histological fibrosis progression, and survival.
  
  
  RESULTS
  Survival and fibrosis progression were similar in patients with tacrolimus and cyclosporine and did not correlate with mean trough levels. In contrast, the application of azathioprine (mean dose of more than 25 mg/d during the first 3 months after OLT) was associated with significantly less progression of fibrosis (P = .01). Administration of azathioprine after the early postoperative phase was not related to the long-term outcome. The dose of prednisolone in the long-term course after OLT significantly correlated with the rate of fibrosis progression (P = .008).
  
  
  CONCLUSIONS
  The clinical course of recurrent hepatitis C was variable. Survival and fibrosis progression did not correlate with the type or trough level of calcineurin inhibitors. Azathioprine early in the course after OLT and prolonged administration of prednisolone were associated with less fibrosis progression.
authors.affiliation: Department of Gastroenterology, Hepatology and Endocrinology, Medizinische Hochschule Hannover, Hannover, Germany. matthias.bahr@gmx.de
authors.forename: M J
authors.initials: MJ
authors.lastname: Bahr
authors.forename: J G P
authors.initials: JG
authors.lastname: Beckermann
authors.forename: K
authors.initials: K
authors.lastname: Rifai
authors.forename: L
authors.initials: L
authors.lastname: Gehrmann
authors.forename: J
authors.initials: J
authors.lastname: Rosenau
authors.forename: J
authors.initials: J
authors.lastname: Klempnauer
authors.forename: C P
authors.initials: CP
authors.lastname: Strassburg
authors.forename: M P
authors.initials: MP
authors.lastname: Manns
mesh_terms: D005260:Female; D006526:Hepatitis C / Q000601:surgery*; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods*; D007166:Immunosuppressive Agents / Q000493:pharmacokinetics / Q000627:therapeutic use; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000276:immunology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000821:virology; D012008:Recurrence; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D007166:Immunosuppressive Agents