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Factors influencing the progression of fibrosis in patients with recurrent hepatitis C after liver transplantation under antiviral therapy: A retrospective analysis of 939 liver biopsies in a single center
Author(s) -
Walter Thomas,
Dumortier Jérôme,
Guillaud Olivier,
Hervieu Valérie,
Scoazec JeanYves,
Boillot Olivier
Publication year - 2007
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.21000
Subject(s) - medicine , gastroenterology , regimen , fibrosis , azathioprine , liver transplantation , cirrhosis , hepatitis c , ribavirin , transplantation , single center , prednisolone , tacrolimus , hepatitis c virus , immunology , virus , disease
Recurrent hepatitis C after liver transplantation (LT) is a major problem, since up to 30% of patients develop cirrhosis only 5 years after LT in the absence of antiviral therapy. The aim of this study was to examine the rate of progression of fibrosis and its associated risk factors in patients submitted to an early antiviral treatment post‐LT. Included in the study were 105 patients submitted to LT between September 1990 and December 2004, 70 of whom were treated with interferon and/or ribavirin. A total of 939 liver biopsies were studied. The median fibrosis stage was 0.8 after 1 year post‐LT, 1.1 after 3 years, 1.3 after 5 years, and 1.5 after 10 years. LT recipients with fibrosis >2 (13% at 10 years) had a significantly reduced survival rate (63% vs. 87% at 10 years, P = 0.03). Univariate analysis disclosed that recipient male gender, antiviral therapy before LT, LT after 1998, induction immunosuppressive regimen including tacrolimus, induction immunosuppressive regimen including mycophenolate (or without azathioprine), and short duration of prednisolone (<12 months) were significantly associated with progression of fibrosis. In a multivariate analysis, recipient male gender ( P = 0.04), antiviral treatment before LT ( P = 0.001), and initial immunosuppressive regimen without azathioprine ( P = 0.03) were associated with progression of fibrosis. In conclusion, our study has documented that fibrosis progression is not linear over time and that occurrence of severe fibrosis is related to previously described factors related to immunosuppressive regimen or donor age and also to a past history of pre‐LT antiviral therapy. Liver Transpl 13:294–301, 2007. © 2007 AASLD.