title: Sirolimus reduces the risk of significant hepatic fibrosis after liver transplantation for hepatitis C virus: a single-center experience.
abstract: BACKGROUND
  Hepatitis C virus (HCV) recurrence following orthotopic liver transplantation is an expected outcome in all patients transplanted for a primary diagnosis of HCV. HCV recurrence has been shown to be associated with graft fibrosis and graft loss. Recent studies suggest that sirolimus (SRL) therapy may slow or inhibit hepatic fibrosis following liver transplant in patients positive for HCV at the time of transplant.
  
  
  METHODS
  Among 313 patients who underwent orthotopic liver transplantation for HCV between 2000 and 2009, 251 qualified for inclusion in the study. Per protocol liver biopsies were performed on all patients at 1 year following liver transplantation and/or at the time of a clinical diagnosis of HCV recurrence. Biopsies were scored for fibrosis using the Batts-Ludwig staging system (0-4); significant fibrosis was defined as fibrosis ≥ stage 2.
  
  
  RESULTS
  Overall, there was no difference in overall survival or graft loss in the SRL compared with the control group. Multivariate analysis revealed SRL therapy to be associated with decreased odds of significant hepatic fibrosis at year 1 postoperatively and over the study duration.
  
  
  CONCLUSIONS
  This retrospective, single-center study showed sirolimus-based immunosuppression to be associated with a lower risk of significant graft fibrosis, both at year 1 and throughout the study period, following liver transplantation in HCV-infected recipients.
authors.affiliation: Division of Transplant Surgery, University of Colorado Health Sciences Center, Aurora, Colorado, USA. Electronic address: Mara.Kelly@ucdenver.edu.
authors.forename: M A
authors.initials: MA
authors.lastname: Kelly
authors.forename: M
authors.initials: M
authors.lastname: Kaplan
authors.forename: T
authors.initials: T
authors.lastname: Nydam
authors.forename: M
authors.initials: M
authors.lastname: Wachs
authors.forename: T
authors.initials: T
authors.lastname: Bak
authors.forename: I
authors.initials: I
authors.lastname: Kam
authors.forename: M A
authors.initials: MA
authors.lastname: Zimmerman
mesh_terms: D005260:Female; D006085:Graft Survival; D006526:Hepatitis C / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008103:Liver Cirrhosis / Q000517:prevention & control*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D020123:Sirolimus / Q000627:therapeutic use*
chemical_list: D007166:Immunosuppressive Agents; D020123:Sirolimus