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Hepatic steatosis at 1 year is an additional predictor of subsequent fibrosis severity in liver transplant recipients with recurrent hepatitis C virus
Author(s) -
Brandman Danielle,
Pingitore Andrea,
Lai Jennifer C.,
Roberts John P.,
Ferrell Linda,
Bass Nathan M.,
Terrault Norah A.
Publication year - 2011
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.22389
Subject(s) - medicine , steatosis , liver transplantation , gastroenterology , liver fibrosis , fibrosis , hepatitis a virus , hepatitis c virus , virus , virology , transplantation
Recurrent hepatitis C virus (HCV) is the most common cause of graft loss for HCV‐infected recipients of liver transplantation (LT). Diabetes mellitus (DM) has been associated with increased rates of fibrosis progression, but whether steatosis affects post‐LT outcomes independently of DM is unclear. Using a retrospective cohort of HCV‐infected LT recipients, we determined the prevalence of hepatic steatosis and evaluated the relationship between steatosis on index biopsy 1 year after LT (±6 months) and the severity of the subsequent fibrosis. One hundred fifty‐two LT recipients with HCV were followed up for a median of 2.09 years (range = 0.13‐6.17 years) after index biopsy; the median number of biopsy procedures per patient after index biopsy was 2 (range = 1‐6). Steatosis (≥5%) was present in 45 individuals (29.6%) according to index biopsy samples taken 1 year after LT; the steatosis was mild (grade 1) in 80% of the patients. In the multivariate analysis, the presence of steatosis 1 year after LT was positively associated with HCV genotype 3 [odds ratio (OR) = 3.60, P = 0.02], older donor age (OR = 1.03, P = 0.04), and pre‐LT hypertension (OR = 3.29, P = 0.009). Two years after index biopsy, the cumulative rate of significant fibrosis (F2‐F4 on the Ludwig‐Batts scale) was 49% in the patients with steatosis at 1 year and 24% in the patients without steatosis ( P = 0.003). In the multivariate analysis, steatosis at 1 year was an independent predictor of subsequent F2 to F4 fibrosis (HR = 2.63, 95% CI = 1.49‐4.63). Steatosis was a stronger predictor of fibrosis in the setting of sirolimus use (hazard ratio = 9.38, 95% confidence interval = 1.37‐64.16, P = 0.02). In conclusion, steatosis is frequent in the early post‐LT period, and steatosis within the first year after LT is a marker of a higher risk of fibrosis progression in HCV‐infected patients. Liver Transpl, 2011. © 2011 AASLD.