title: Assessment of disease progression in patients with transfusion-associated chronic hepatitis C using transient elastography.
abstract: OBJECTIVE
  To evaluate the relationship between liver stiffness and duration of infection in blood transfusion-associated hepatitis C virus (HCV) patients with or without hepatocellular carcinoma (HCC).
  
  
  METHODS
  Between December 2006 and June 2008, a total of 524 transfusion-associated HCV-RNA positive patients with or without HCC were enrolled. Liver stiffness was obtained noninvasively by using Fibroscan (Echosens, Paris, France). The date of blood transfusion was obtained by interview. Duration of infection was derived from the interval between the date of blood transfusion and the date of liver stiffness measurement (LSM). Patients were stratified into four groups based on the duration of infection (17-29 years; 30-39 years; 40-49 years; and 50-70 years). The difference in liver stiffness between patients with and without HCC was assessed in each group. Multiple linear regression analysis was used to determine the factors associated with liver stiffness.
  
  
  RESULTS
  A total of 524 patients underwent LSM. Eight patients were excluded because of unsuccessful measurements. Thus 516 patients were included in the current analysis (225 with HCC and 291 without). The patients were 244 men and 272 women, with a mean age of 67.8 ± 9.5 years. The median liver stiffness was 14.3 kPa (25.8 in HCC group and 7.6 in non-HCC group). The patients who developed HCC in short duration of infection were male dominant, having lower platelet count, with a history of heavier alcohol consumption, showing higher liver stiffness, and receiving blood transfusion at an old age. Liver stiffness was positively correlated with duration of infection in patients without HCC (r = 0.132, P = 0.024) but not in patients with HCC (r = -0.103, P = 0.123). Liver stiffness was significantly higher in patients with HCC than in those without in each duration group (P < 0.0001). The factors significantly associated with high liver stiffness in multiple regression were age at blood transfusion (P < 0.0001), duration of infection (P = 0.0015), and heavy alcohol consumption (P = 0.043).
  
  
  CONCLUSIONS
  Although liver stiffness gradually increases over time, HCC develops in patients with high stiffness value regardless of the duration of infection.
authors.affiliation: Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 1138655 Tokyo, Japan. ryota-m@umin.net
authors.forename: Ryota
authors.initials: R
authors.lastname: Masuzaki
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Tateishi
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Yoshida
authors.forename: Toru
authors.initials: T
authors.lastname: Arano
authors.forename: Koji
authors.initials: K
authors.lastname: Uchino
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Enooku
authors.forename: Eriko
authors.initials: E
authors.lastname: Goto
authors.forename: Hayato
authors.initials: H
authors.lastname: Nakagawa
authors.forename: Yoshinari
authors.initials: Y
authors.lastname: Asaoka
authors.forename: Yuji
authors.initials: Y
authors.lastname: Kondo
authors.forename: Tadashi
authors.initials: T
authors.lastname: Goto
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Ikeda
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Shiina
authors.forename: Masao
authors.initials: M
authors.lastname: Omata
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Koike
mesh_terms: D000368:Aged; D018450:Disease Progression; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D019698:Hepatitis C, Chronic / Q000209:etiology* / Q000473:pathology* / Q000503:physiopathology*; D006801:Humans; D008099:Liver / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D065227:Transfusion Reaction