title: Digital image analysis of liver collagen predicts clinical outcome of recurrent hepatitis C virus 1 year after liver transplantation.
abstract: Clinical outcomes of recurrent hepatitis C virus after liver transplantation are difficult to predict. We evaluated collagen proportionate area (CPA), a quantitative histological index, at 1 year with respect to the first episode of clinical decompensation. Patients with biopsies at 1 year after liver transplantation were evaluated by Ishak stage/grade, and biopsy samples stained with Sirius red for digital image analysis were evaluated for CPA. Cox regression was used to evaluate variables associated with first appearance of clinical decompensation. Receiver operating characteristic (ROC) curves were also used. A total of 135 patients with median follow-up of 76 months were evaluated. At 1 year, median CPA was 4.6% (0.2%-36%) and Ishak stage was 0-2 in 101 patients, 3-4 in 23 patients, and 5-6 in 11 patients. Decompensation occurred in 26 (19.3%) at a median of 61 months (15-138). Univariately, CPA, tacrolimus monotherapy, and Ishak stage/grade at 1 year were associated with decompensation; upon multivariate analysis, only CPA was associated with decompensation (P = 0.010; Exp(B) = 1.169; 95%CI, 1.037-1.317). Area under the ROC curve was 0.97 (95%CI, 0.94-0.99). A cutoff value of 6% of CPA had 82% sensitivity and 95% specificity for decompensation. In the 89 patients with hepatic venous pressure gradient (HVPG) measurement, similar results were obtained. When both cutoffs of CPA > 6% and HVPG ≥ 6 mm Hg were used, all patients decompensated. Thus, CPA at 1-year biopsy after liver transplantation was highly predictive of clinical outcome in patients infected with hepatitis C virus who underwent transplantation, better than Ishak stage or HVPG.
authors.affiliation: The Royal Free Sheila Sherlock Liver Centre and Division of Surgery and Interventional Sciences, University College London, London, UK.
authors.forename: Pinelopi
authors.initials: P
authors.lastname: Manousou
authors.forename: Amar P
authors.initials: AP
authors.lastname: Dhillon
authors.forename: Graziela
authors.initials: G
authors.lastname: Isgro
authors.forename: Vincenza
authors.initials: V
authors.lastname: Calvaruso
authors.forename: T V
authors.initials: TV
authors.lastname: Luong
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Tsochatzis
authors.forename: E
authors.initials: E
authors.lastname: Xirouchakis
authors.forename: G
authors.initials: G
authors.lastname: Kalambokis
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Cross
authors.forename: N
authors.initials: N
authors.lastname: Rolando
authors.forename: James
authors.initials: J
authors.lastname: O'Beirne
authors.forename: David
authors.initials: D
authors.lastname: Patch
authors.forename: D
authors.initials: D
authors.lastname: Thornburn
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Burroughs
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy; D002648:Child; D003094:Collagen / Q000378:metabolism*; D058625:End Stage Liver Disease / Q000473:pathology / Q000503:physiopathology / Q000601:surgery* / Q000821:virology; D005260:Female; D006503:Hepatic Veins / Q000503:physiopathology; D006526:Hepatitis C / Q000150:complications / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D053208:Kaplan-Meier Estimate; D008099:Liver / Q000098:blood supply / Q000378:metabolism* / Q000473:pathology / Q000601:surgery* / Q000821:virology; D008103:Liver Cirrhosis / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology / Q000601:surgery* / Q000821:virology; D016031:Liver Transplantation / Q000009:adverse effects*; D008131:London; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012372:ROC Curve; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013997:Time Factors; D014690:Venous Pressure; D055815:Young Adult
chemical_list: D003094:Collagen