Open AccessClinical outcome of HCV‐related graft cirrhosis and prognostic value of hepatic venous pressure gradient
Author(s) -
Kalambokis Georgios,
Manousou Pinelopi,
Samonakis Dimitrios,
Grillo Federica,
Dhillon Amar P.,
Patch David,
O’Beirne James,
Rolles Keith,
Burroughs Andrew K.
Publication year - 2009
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/j.1432-2277.2008.00744.x
Subject(s) - medicine , decompensation , cirrhosis , portal venous pressure , liver transplantation , gastroenterology , immunosuppression , transplantation , hepatitis c , portal hypertension , surgery
Summary Hepatitis C virus (HCV) allograft cirrhosis may progress rapidly requiring re‐transplantation but its course is little studied. We evaluated serially biopsied patients who developed HCV‐related allograft cirrhosis. We assessed outcome of graft cirrhosis in 55 out of 234 consecutive patients and predictors of decompensation and mortality, including hepatic venous pressure gradient (HVPG) in 38. Allograft cirrhosis (Ishak stage 6, 60%; stage 5, 40%) was diagnosed between 12 and 172 months (median, 52) from transplantation; subsequent follow up was 22 (1–78) months. Faster development (≤48 months) was associated with tacrolimus and nonuse of azathioprine and prednisolone. Decompensation occurred in 22% with a probability of not developing decompensation reaching 60% at 5 years. Survival among compensated patients was 77% at 5 years, but fell rapidly after decompensation (12% at 1 year). Decompensation and mortality were independently associated with HVPG ≥ 10 mmHg, Child‐Pugh score ≥ 7, and albumin levels ≤ 32 g/dl but not with fibrosis stage 5 or 6, HCV genotype (1b, 34%) or immunosuppression used after diagnosis of cirrhosis. In conclusion, Ishak stage 5 and 6 HCV‐related cirrhosis have similar prognosis after liver transplantation. An HVPG ≥ 10 mmHg, in addition to liver dysfunction, gives independent prognostic information prior to decompensation, allowing early relisting before prognosis becomes extremely poor.