Excess body weight, liver steatosis, and early fibrosis progression due to hepatitis C recurrence after liver transplantation.
OBJECTIVE
To investigate how weight gain after OLT affects the speed of fibrosis progression (SFP) during recurrent hepatitis C virus (HCV) infection of the graft.


METHODS
Ninety consecutive patients (63 males, median age 53 years; 55 with HCV-related liver disease), transplanted at a single institution, were studied. All were followed for at least 2 years after OLT and had at least one follow-up graft biopsy, performed not earlier than 1 year after the transplant operation. For each biopsy, a single, experienced pathologist gave an estimate of both the staging according to Ishak and the degree of hepatic steatosis. The SFP was quantified in fibrosis units/month (FU/mo). The lipid metabolism status of patients was summarized by the plasma triglycerides/cholesterol (T/C) ratio. Body mass index (BMI) was measured before OLT, and 1 and 2 years after it.


RESULTS
In the HCV positive group, the highest SFP was observed in the first post-OLT year. At that time point, a SFP <=0.100 FU/mo was observed more frequently among recipients who had received their graft from a young donor and had a pre-transplant BMI value >26.0 kg/m(2). At completion of the first post-transplant year, a BMI value >26.5 kg/m(2) was associated with a T/C ratio <=1. The proportion of patients with SFP >0.100 FU/mo descended in the following order: female recipients with a high T/C ratio, male recipients with high T/C ratio, and recipients of either gender with low T/C ratio. Hepatic steatosis was observed more frequently in recipients who, in the first post-transplant year, had increased their BMI >=1.5 kg/m(2) in comparison to the pre-transplant value. Hepatic steatosis was inversely associated with the staging score.


CONCLUSIONS
Among HCV positive recipients, excess weight gain post-OLT does not represent a factor favoring early liver fibrosis development and might even be protective against it.
Toniutto
Pierluigi
P
Clinica di Medicina Interna, Universita degli Studi, Piazzale Santa Maria della Misericordia, 1, Udine 33100, Italy. pierluigi.toniutto@uniud.it
Fabris
Carlo
C
Avellini
Claudio
C
Minisini
Rosalba
R
Bitetto
Davide
D
Rossi
Elisabetta
E
Smirne
Carlo
C
Pirisi
Mario
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D005234:Fatty Liver / Q000209:etiology; D005260:Female; D006526:Hepatitis C / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008055:Lipids / Q000097:blood; D008103:Liver Cirrhosis / Q000209:etiology; D016031:Liver Transplantation / Q000009:adverse effects* / Q000473:pathology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D015430:Weight Gain
D008055:Lipids