title: Hepatitis C in Liver Allograft Recipients: Utility of One-Year Post-Transplantation Biopsy as an Indicator of Antiviral Therapy.
abstract: BACKGROUND
  All-oral interferon-free regimens for hepatitis C viral (HCV) infection are highly efficacious; however, high cost is a barrier to applicability. Liver allograft recipients are particularly likely to benefit from therapy as HCV often leads to graft dysfunction and loss. In this study, we aimed to establish the utility of allograft biopsy at 1 year post-transplant as an indicator of treatment.
  
  
  RESULTS
  Among 252 liver recipients enrolled, 136 (54%) developed severe disease (fibrosing cholestatic hepatitis (FCH) or fibrosis stage ≥ 2 at 1 year post-transplant). Multivariable analysis revealed younger recipient age and female gender, older donor age and T cell depletive therapy to be independent predictors of severe disease. Recipients with severe disease had higher rate of further graft loss compared to those with mild disease. Patients with mild disease and sustained virologic response (SVR) had the best survival rate, whereas those with severe disease and viremia had the worst survival (96% versus 63% at 5 years).
  
  
  CONCLUSIONS
  In conclusion, allograft biopsy at 1 year helps identify recipients at high risk of further graft dysfunction and loss. In view of high cost of therapy, treatment should be preferably directed to high-risk patients including those with FCH or fibrosis stage ≥ 2 by 1 year post-transplant.
authors: Division of Gastroenterology & Hepatology, Liver Research Institute, University of Arizona, Tucson, AZ, USA.
authors: Shahid
authors: S
authors: Habib
authors: Division of Gastroenterology, Hepatology & Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors: Shahid
authors: S
authors: Malik
authors: Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
authors: Bo
authors: B
authors: Fu
authors: Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors: Joyce
authors: J
authors: Chang
authors: Division of Transplantation Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors: Michael
authors: M
authors: Nalesnik
authors: Division of Transplantation Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors: Abhinav
authors: A
authors: Humar
authors: Division of Gastroenterology, Hepatology & Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors: Obaid S
authors: OS
authors: Shaikh
keywords: Antiviral agent; Hepatitis C; Immunosuppression; Liver fibrosis; Transplantation