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.
Liver Unit, Institut de Malalties Digestives, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.
Alejandro
A
Blasco
Xavier
X
Forns
José A
JA
Carrión
Juan Carlos
JC
García-Pagán
Rosa
R
Gilabert
Antoni
A
Rimola
Rosa
R
Miquel
Miquel
M
Bruguera
Juan-Carlos
JC
García-Valdecasas
Jaime
J
Bosch
Miquel
M
Navasa
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