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Histological recurrence and progression of hepatitis C after orthotopic liver transplantation: Influence of immunosuppressive regimens
Author(s) -
Hunt John,
Gordon Fredric D.,
Lewis W. David,
Pomfret Elizabeth,
Pomposelli James J.,
Jenkins Roger L.,
Khettry Urmila
Publication year - 2001
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 - 10.1053/jlts.2001.27803
Subject(s) - medicine , gastroenterology , hepatitis c , liver biopsy , hepatitis , liver transplantation , azathioprine , regimen , fibrosis , immunosuppression , biopsy , transplantation , disease
Post–orthotopic liver transplantation (OLT) recurrence of hepatitis C is virtually universal, but histological progression of disease is not. This study examines long‐term clinical and liver histological features at and after OLT to elucidate factors predictive of hepatitis C recurrence and progression after OLT. A blinded retrospective review of clinical, serological, and histopathologic features of 65 patients who underwent OLT for hepatitis C and Non A Non B hepatitis was conducted. Histological findings of recurrent hepatitis C and progression (fibrosis, ≥ grade 2 by last follow‐up) were correlated with clinical parameters. Histological recurrence of hepatitis C was seen in 43 of 65 patients, with progression in 19 patients. Histological findings in the native liver and post‐OLT biopsy specimen at the time of recurrence showed no correlation with hepatitis C recurrence and progression. Patients treated with azathioprine (AZA)‐containing immunosuppressive regimens experienced less recurrence (6 of 17 v 37 of 48 patients; P < .005) and progression (1 of 17 v 18 of 48 patients; P = .014) than those without AZA as part of their immunosuppressive regimen. No difference was seen between patients treated with cyclosporine versus those administered FK506 ( P > .05). Histological recurrence of hepatitis C after OLT is seen in 66% of patients with progressive disease and 29% of all patients. The grade of inflammation in the native liver at the time of OLT and time of recurrence is not predictive of progression. AZA‐containing regimens reduce histological recurrence and progression of hepatitis C in post‐OLT patients.