title: Clinical outcome of HCV-related graft cirrhosis and prognostic value of hepatic venous pressure gradient.
abstract: Hepatitis C virus (HCV) allograft cirrhosis may progress rapidly requiring re-transplantation but its course is little studied. We evaluated serially biopsied patients who developed HCV-related allograft cirrhosis. We assessed outcome of graft cirrhosis in 55 out of 234 consecutive patients and predictors of decompensation and mortality, including hepatic venous pressure gradient (HVPG) in 38. Allograft cirrhosis (Ishak stage 6, 60%; stage 5, 40%) was diagnosed between 12 and 172 months (median, 52) from transplantation; subsequent follow up was 22 (1-78) months. Faster development (<or=48 months) was associated with tacrolimus and nonuse of azathioprine and prednisolone. Decompensation occurred in 22% with a probability of not developing decompensation reaching 60% at 5 years. Survival among compensated patients was 77% at 5 years, but fell rapidly after decompensation (12% at 1 year). Decompensation and mortality were independently associated with HVPG >or= 10 mmHg, Child-Pugh score >or= 7, and albumin levels <or= 32 g/dl but not with fibrosis stage 5 or 6, HCV genotype (1b, 34%) or immunosuppression used after diagnosis of cirrhosis. In conclusion, Ishak stage 5 and 6 HCV-related cirrhosis have similar prognosis after liver transplantation. An HVPG >or= 10 mmHg, in addition to liver dysfunction, gives independent prognostic information prior to decompensation, allowing early relisting before prognosis becomes extremely poor.
authors.affiliation: The Royal Free Sheila Sherlock Liver Centre, University Department of Surgery, Royal Free Hospital, London, UK.
authors.forename: Georgios
authors.initials: G
authors.lastname: Kalambokis
authors.forename: Pinelopi
authors.initials: P
authors.lastname: Manousou
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Samonakis
authors.forename: Federica
authors.initials: F
authors.lastname: Grillo
authors.forename: Amar P
authors.initials: AP
authors.lastname: Dhillon
authors.forename: David
authors.initials: D
authors.lastname: Patch
authors.forename: James
authors.initials: J
authors.lastname: O'Beirne
authors.forename: Keith
authors.initials: K
authors.lastname: Rolles
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Burroughs
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006085:Graft Survival; D006503:Hepatic Veins / Q000503:physiopathology; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D008103:Liver Cirrhosis / Q000503:physiopathology / Q000601:surgery / Q000821:virology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D016896:Treatment Outcome; D014690:Venous Pressure / Q000502:physiology