Serum fibrosis markers identify patients with mild and progressive hepatitis C recurrence after liver transplantation.
OBJECTIVE
Significant fibrosis (fibrosis stage [F] >or= 2) and portal hypertension (hepatic venous pressure gradient [HVPG] >or= 6 mm Hg) in patients 1 year after liver transplantation indicate progressive hepatitis C recurrence. This study evaluated whether serum fibrosis markers can predict hepatitis C recurrence during the first year after liver transplantation.


METHODS
Hyaluronic acid, amino-terminal propeptide of type-III-procollagen, tissue inhibitor of matrix metalloproteinase type-1 concentrations were measured in serum samples from 133 patients infected with hepatitis C virus (HCV) at 3, 6, and 12 months after liver transplantation; routine laboratory tests were also performed. Liver biopsy samples (n = 133) and HVPGs (n = 94) were analyzed 1 year after transplantation. Sixteen patients who were not infected with HCV served as controls.


RESULTS
An algorithm, including the 3 markers (3-M-ALG) and 3 published scores (aspartate aminotransferase [AST]-to-alanine aminotransferase ratio, AST-to-platelet ratio index, and Benlloch) were analyzed. One year after liver transplantation, 50 patients (38%) had significant fibrosis (F >or= 2) and 31 (32%) had an HVPG >or= 6 mm Hg. The area under the receiver operator characteristic curve of the 3-M-ALG used to identify F >or= 2 at 3, 6, and 12 months after transplantation (0.67, 0.77, and 0.78) and of those with HVPG >or= 6 at the same time points (0.75, 0.87, and 0.90) were significantly higher than values obtained with the 3 published scores. At 12 months, a 3-M-ALG >or= 2 identified most patients at risk of decompensation/death.


CONCLUSIONS
Serum markers can accurately discriminate between patients with mild and progressive hepatitis C recurrence after liver transplantation.
Liver Unit, Institut de Malalties Digestives, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, CIBERehd, Barcelona, Spain.
José A
JA
Carrión
Guillermo
G
Fernández-Varo
Miquel
M
Bruguera
Juan-Carlos
JC
García-Pagán
Juan-Carlos
JC
García-Valdecasas
Sofía
S
Pérez-Del-Pulgar
Xavier
X
Forns
Wladimiro
W
Jiménez
Miquel
M
Navasa
D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D000465:Algorithms; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood*; D001706:Biopsy; D005260:Female; D005500:Follow-Up Studies; D019698:Hepatitis C, Chronic / Q000097:blood* / Q000175:diagnosis* / Q000401:mortality; D006801:Humans; D006975:Hypertension, Portal / Q000097:blood / Q000175:diagnosis / Q000401:mortality; D008103:Liver Cirrhosis / Q000097:blood* / Q000175:diagnosis* / Q000401:mortality; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis / Q000401:mortality; D011237:Predictive Value of Tests; D012008:Recurrence; D015203:Reproducibility of Results; D012307:Risk Factors; D012720:Severity of Illness Index; D055815:Young Adult
D015415:Biomarkers; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase