Hepatic venous pressure gradient identifies patients at risk of severe hepatitis C recurrence after liver transplantation.
Liver biopsy is essential in the follow-up of HCV-infected liver transplant recipients. The aim of this study was to prospectively compare percutaneous (PLB) versus transjugular liver biopsy (TLB) in the assessment of liver damage. We also explored the diagnostic value of hepatic venous pressure gradient (HVPG) to identify patients at risk of severe HCV disease recurrence after liver transplantation (LT). One hundred sixteen paired PLB and TLB (with HVPG measurement) were performed 3 or 12 months after LT in 80 patients. Concordance for necroinflammation and fibrosis was fair or good, particularly 1 year after LT (kappa > or = 0.6). At this point, a significant positive association was seen between the median HVPG and the fibrosis stage (2.5 mm Hg for F0; 5 mm Hg for F1, 6 mm Hg for F2, and 11.5 mm Hg for F3; Kruscal-Wallis < 0.001). Despite this strong association, portal hypertension (HVPG > or = 6 mm Hg) was detected in 1 (5%) of 22, 4 (16%) of 25, and 6 (60%) of 10 patients with fibrosis stages 0, 1, and 2, respectively. After a median follow-up of 38 months, clinical decompensation occurred in 15 (19%) of 80 patients. Although the presence of significant fibrosis (F2-F3) 1 year after transplantation was good to predict clinical decompensation (AUC: 0.80), an HVPG of 6 mm Hg or greater was extremely accurate at identifying patients at risk of disease progression (AUC: 0.96). In conclusion, HVPG determination is a valuable tool for follow-up in patients with HCV recurrence after LT.
Blasco
Alejandro
A
Liver Unit, Institut de Malalties Digestives, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.
Forns
Xavier
X
Carrión
José A
JA
García-Pagán
Juan Carlos
JC
Gilabert
Rosa
R
Rimola
Antoni
A
Miquel
Rosa
R
Bruguera
Miquel
M
García-Valdecasas
Juan-Carlos
JC
Bosch
Jaime
J
Navasa
Miquel
M
D000328:Adult; D000368:Aged; D001707:Biopsy, Needle / Q000379:methods*; D018450:Disease Progression; D005260:Female; D006503:Hepatic Veins; D019698:Hepatitis C, Chronic / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D006975:Hypertension, Portal; D008099:Liver / Q000473:pathology* / Q000503:physiopathology; D008102:Liver Circulation; D008103:Liver Cirrhosis / Q000473:pathology; D016031:Liver Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012306:Risk; D014690:Venous Pressure