title: Severe fibrosis in patients with recurrent hepatitis C after liver transplantation: a French experience on 250 patients over 15 years (the Orfèvre study).
abstract: OBJECTIVE
  Recurrent hepatitis C after liver transplantation (LT) is associated with rapid fibrosis progression. The aim of this study was to evaluate the cumulative risk for severe fibrosis and the factors influencing it.
  
  
  METHODS
  Two hundred and fifty LT patients were included 1 to 15years after LT. Recurrence of chronic hepatitis C on liver graft was classified according to Metavir score.
  
  
  RESULTS
  Kaplan-Meyer estimates for actuarial progression to severe fibrosis (Metavir>F3) showed a probability of 15.2% and 44.5% at 5 and 10years, respectively. Predictive factors for progression to severe fibrosis were: use of tacrolimus as main CNI, recipient age at time of biopsy<55, donor age ≥45, graft HCV re-infection<3months, biologically suspected graft re-infection and lack of response to antiviral treatment after LT. Multivariate analysis disclosed that only donor age ≥45 (hazard ratio 2.243, 95%CI 1.264-3.983, P=0.0058) and lack of response to antiviral treatment (hazard ratio 2.816, 95%CI 1.227-6.464, P=0.0146) were associated to severe fibrosis.
  
  
  CONCLUSIONS
  Our study confirms that donor age ≥45 and lack of response to antiviral treatment after LT are major predictive factors of progression of HCV recurrence on liver graft.
authors.affiliation: Unité de transplantation hépatique-fédération des spécialités digestives, HCL, pavillon D, hôpital Edouard-Herriot, 69437 Lyon cedex 03, France. Electronic address: jerome.dumortier@chu-lyon.fr.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Dumortier
authors.affiliation: Service de chirurgie digestive et transplantation hépatique, hôpital Trousseau, 37170 Chambray-lès-Tours, France.
authors.forename: Ephrem
authors.initials: E
authors.lastname: Salamé
authors.affiliation: Centre hépato-biliaire, hôpital Paul-Brousse, AP-HP, 94804 Villejuif, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Roche
authors.affiliation: Service d'hépatologie, hôpital Henri-Mondor, AP-HP, 94000 Créteil, France.
authors.forename: Monika
authors.initials: M
authors.lastname: Hurtova
authors.affiliation: Service de chirurgie, hôpital Cochin, AP-HP, 75014 Paris, France.
authors.forename: Filomena
authors.initials: F
authors.lastname: Conti
authors.affiliation: Service d'hépatologie, HCL, hôpital de la Croix-Rousse, 69205 Lyon, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Radenne
authors.affiliation: Service d'hépatologie, hôpital Jean-Minjoz, CHU de Besançon, 25030 Besançon, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Vanlemmens
authors.affiliation: Fédération médico-chirurgicale des maladies de l'appareil digestif, hôpital Saint-Eloi, 34295 Montpellier, France.
authors.forename: Georges-Philippe
authors.initials: GP
authors.lastname: Pageaux
authors.affiliation: Centre hépato-biliaire, hôpital Paul-Brousse, AP-HP, 94804 Villejuif, France.
authors.forename: Faouzi
authors.initials: F
authors.lastname: Saliba
authors.affiliation: Centre hépato-biliaire, hôpital Paul-Brousse, AP-HP, 94804 Villejuif, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Samuel
authors.affiliation: Service de chirurgie digestive et hépato-biliaire - transplantation hépatique, hôpital Henri-Mondor, AP-HP, 94000 Créteil, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Compagnon
authors.affiliation: Laboratoire d'immunologie, hôpital Pellegrin, 33076 Bordeaux, France.
authors.forename: Martine
authors.initials: M
authors.lastname: Neau-Cransac
authors.affiliation: Service de chirurgie, hôpital Cochin, AP-HP, 75014 Paris, France.
authors.forename: Yvon
authors.initials: Y
authors.lastname: Calmus
authors.affiliation: Unité de transplantation hépatique-fédération des spécialités digestives, HCL, pavillon D, hôpital Edouard-Herriot, 69437 Lyon cedex 03, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Guillaud
authors.affiliation: Service de chirurgie digestive, hôpital L'Archet 2, CHU de Nice, 06202 Nice, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Gugenheim
authors.affiliation: Service de chirurgie digestive, CHU de Côte de Nacre, 14033 Caen, France.
authors.forename: Mario
authors.initials: M
authors.lastname: Altieri
authors.affiliation: Service d'hépatologie, hôpital Beaujon, AP-HP, 92118 Clichy, France.
authors.forename: François
authors.initials: F
authors.lastname: Durand
authors.affiliation: Service de chirurgie digestive, hôpital la Conception, 13385 Marseille, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Hardwigsen
authors.affiliation: Service de chirurgie hépato-biliaire et digestive, hôpital de Pontchaillou, 35033 Rennes, France.
authors.forename: Richard
authors.initials: R
authors.lastname: Lorho
authors.affiliation: Service d'hépatologie, hôpital Claude-Huriez, 59000 Lille, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Dharancy
authors.affiliation: Service d'hépato-gastro-entérologie, hôpital A.-Michallon, 38700 La Tronche, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Leroy
authors.affiliation: Novartis Pharma SAS, 92506 Rueil-Malmaison, France.
authors.forename: Fabienne
authors.initials: F
authors.lastname: Di Giambattista
authors.affiliation: Service d'hépatologie, hôpital Henri-Mondor, AP-HP, 94000 Créteil, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Duvoux
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000998:Antiviral Agents / Q000009:adverse effects; D003430:Cross-Sectional Studies; D018450:Disease Progression; D004351:Drug Resistance; D005260:Female; D005602:France / Q000453:epidemiology; D019698:Hepatitis C, Chronic / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D008103:Liver Cirrhosis / Q000453:epidemiology*; D016031:Liver Transplantation; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012008:Recurrence; D012720:Severity of Illness Index; D014019:Tissue Donors
chemical_list: D000998:Antiviral Agents