title: Angiotensin blockade does not affect fibrosis progression in recurrent hepatitis C after liver transplantation.
abstract: BACKGROUND
  Liver transplantation (LT) for hepatitis C virus (HCV)-related end-stage liver disease is impaired by universal disease recurrence and suboptimal response to antiviral therapy. Inhibition of angiotensin-II signalling by angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin-II receptor blockers (ARB) decreases hepatic stellate cell activation in vitro and hepatic fibrogenesis in animal models. A single-center retrospective analysis suggested that angiotensin blockade (AB) inhibits fibrosis progression in recurrent HCV post-LT. This study assessed the effect of AB on fibrosis progression in an independent patient cohort.
  
  
  METHODS
  Chart review of all patients who underwent transplantation in our institution for HCV-related ESLD between January 2000 and February 2008 revealed 109 patients with ≥2 protocol liver biopsies and free of antiviral therapy post-LT up to the last biopsy analyzed; 27 of 109 patients were treated with ACE-I/ARB for ≥12 months, 82 were not. Fibrosis was staged using METAVIR.
  
  
  RESULTS
  Live-donor LT was more frequent in controls than in the AB group (25% vs 11%; P < .05). However, parameters known to affect outcome of recurrent HCV, including donor age, prevalence of diabetes, acute cellular rejection, and immunosuppression, were similar in both groups. Time between first and last biopsy (median, 23 months), stage of fibrosis, fibrosis progression rates (median 0.47 vs 0.45 unit/y; P = .46), and time to develop fibrosis stage ≥2 did not differ between groups. Results held true if deceased-donor LT were analyzed separately.
  
  
  CONCLUSIONS
  Our study does not support the contention of a previous report that use of AB reduces fibrosis progression in recurrent HCV post-LT.
authors: Multiorgan Transplant Program, and Department of Pathology, University Health Network, University of Toronto, Toronto, ON, Canada.
authors: O
authors: O
authors: Guillaud
authors: K C
authors: KC
authors: Gurram
authors: M
authors: M
authors: Puglia
authors: L
authors: L
authors: Lilly
authors: O
authors: O
authors: Adeyi
authors: E L
authors: EL
authors: Renner
authors: N
authors: N
authors: Selzner
mesh_terms: D000328:Adult; D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000627:therapeutic use; D001706:Biopsy; D018450:Disease Progression; D058625:End Stage Liver Disease / Q000175:diagnosis / Q000601:surgery* / Q000821:virology; D005260:Female; D006526:Hepatitis C / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000517:prevention & control* / Q000821:virology; D016031:Liver Transplantation / Q000009:adverse effects; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000998:Antiviral Agents