Explanted liver inflammatory grade predicts fibrosis progression in hepatitis C recurrence

Marwan Ghabril, Rolland Dickson, Murli Krishna, Victor MacHicao, Jaime Aranda-Michel, Hugo Bonatti, Justin H Nguyen

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Factors present prior to liver transplantation (LT) that predict fibrosis progression in recurrent hepatitis C infection (HCV) after LT would be important to identify. This study sought to determine if histologic grade of HCV in the explant predicts fibrosis progression in recurrent HCV. The clinical and histologic data of all 159 patients undergoing their first LT for HCV at our center from 1998 to 2001 were retrospectively reviewed with follow-up through June 2008. Twenty-five cases were excluded for: non-HCV-related graft loss <90 days (19), recidivism (4), or unavailable explant or follow-up biopsies (2). A single pathologist scored (Ishak) explants in a blinded fashion. Patients were grouped by explant inflammatory grade ≤4 (group1) and >4 (group 2). Prospectively scored liver biopsies (protocol months 1 and 4, annually, and as indicated clinically) were reviewed for development of advanced fibrosis (bridging or cirrhosis). Cox proportional hazard regression was used to analyze the association of explant grade, donor, viral and LT factors with progression to advanced fibrosis. The groups were well-matched for patient, viral, donor, and transplant factors. Five-year advanced fibrosis-free survival in group 1 versus group 2 was 63% versus 28%, P < 0.001. Explant grade >4 was associated with increased HCV-related graft loss at 1 (6% versus 3%) and 5 (36% versus 14%) years post-LT (P = 0.003). On univariate and multivariate Cox regression analysis, predictors of advanced fibrosis were explant grade >4 (hazard ratio [HR] = 3.3, 95% confidence interval [CI] = 1.9-5.6, P < 0.001) donor age >50 (HR = 3.3, 95% CI = 1.9-5.7, P < 0.001) and viral load at LT of >158,730 IU/mL (HR = 1.8, 95% CI = 1.05-3.1, P = 0.03). Conclusion: Explant histologic grade can identify patients requiring more aggressive monitoring and intervention for HCV recurrence post-LT. Liver Transpl 17:685-694, 2011.

Original languageEnglish (US)
Pages (from-to)685-694
Number of pages10
JournalLiver Transplantation
Volume17
Issue number6
DOIs
StatePublished - Jun 2011

Fingerprint

Hepatitis C
Liver Transplantation
Fibrosis
Recurrence
Liver
Confidence Intervals
Tissue Donors
Transplants
Regression Analysis
Biopsy
Survival
Infection

ASJC Scopus subject areas

  • Surgery
  • Transplantation
  • Hepatology

Cite this

Explanted liver inflammatory grade predicts fibrosis progression in hepatitis C recurrence. / Ghabril, Marwan; Dickson, Rolland; Krishna, Murli; MacHicao, Victor; Aranda-Michel, Jaime; Bonatti, Hugo; Nguyen, Justin H.

In: Liver Transplantation, Vol. 17, No. 6, 06.2011, p. 685-694.

Research output: Contribution to journalArticle

Ghabril, Marwan ; Dickson, Rolland ; Krishna, Murli ; MacHicao, Victor ; Aranda-Michel, Jaime ; Bonatti, Hugo ; Nguyen, Justin H. / Explanted liver inflammatory grade predicts fibrosis progression in hepatitis C recurrence. In: Liver Transplantation. 2011 ; Vol. 17, No. 6. pp. 685-694.
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abstract = "Factors present prior to liver transplantation (LT) that predict fibrosis progression in recurrent hepatitis C infection (HCV) after LT would be important to identify. This study sought to determine if histologic grade of HCV in the explant predicts fibrosis progression in recurrent HCV. The clinical and histologic data of all 159 patients undergoing their first LT for HCV at our center from 1998 to 2001 were retrospectively reviewed with follow-up through June 2008. Twenty-five cases were excluded for: non-HCV-related graft loss <90 days (19), recidivism (4), or unavailable explant or follow-up biopsies (2). A single pathologist scored (Ishak) explants in a blinded fashion. Patients were grouped by explant inflammatory grade ≤4 (group1) and >4 (group 2). Prospectively scored liver biopsies (protocol months 1 and 4, annually, and as indicated clinically) were reviewed for development of advanced fibrosis (bridging or cirrhosis). Cox proportional hazard regression was used to analyze the association of explant grade, donor, viral and LT factors with progression to advanced fibrosis. The groups were well-matched for patient, viral, donor, and transplant factors. Five-year advanced fibrosis-free survival in group 1 versus group 2 was 63{\%} versus 28{\%}, P < 0.001. Explant grade >4 was associated with increased HCV-related graft loss at 1 (6{\%} versus 3{\%}) and 5 (36{\%} versus 14{\%}) years post-LT (P = 0.003). On univariate and multivariate Cox regression analysis, predictors of advanced fibrosis were explant grade >4 (hazard ratio [HR] = 3.3, 95{\%} confidence interval [CI] = 1.9-5.6, P < 0.001) donor age >50 (HR = 3.3, 95{\%} CI = 1.9-5.7, P < 0.001) and viral load at LT of >158,730 IU/mL (HR = 1.8, 95{\%} CI = 1.05-3.1, P = 0.03). Conclusion: Explant histologic grade can identify patients requiring more aggressive monitoring and intervention for HCV recurrence post-LT. Liver Transpl 17:685-694, 2011.",
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AU - Bonatti, Hugo

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AB - Factors present prior to liver transplantation (LT) that predict fibrosis progression in recurrent hepatitis C infection (HCV) after LT would be important to identify. This study sought to determine if histologic grade of HCV in the explant predicts fibrosis progression in recurrent HCV. The clinical and histologic data of all 159 patients undergoing their first LT for HCV at our center from 1998 to 2001 were retrospectively reviewed with follow-up through June 2008. Twenty-five cases were excluded for: non-HCV-related graft loss <90 days (19), recidivism (4), or unavailable explant or follow-up biopsies (2). A single pathologist scored (Ishak) explants in a blinded fashion. Patients were grouped by explant inflammatory grade ≤4 (group1) and >4 (group 2). Prospectively scored liver biopsies (protocol months 1 and 4, annually, and as indicated clinically) were reviewed for development of advanced fibrosis (bridging or cirrhosis). Cox proportional hazard regression was used to analyze the association of explant grade, donor, viral and LT factors with progression to advanced fibrosis. The groups were well-matched for patient, viral, donor, and transplant factors. Five-year advanced fibrosis-free survival in group 1 versus group 2 was 63% versus 28%, P < 0.001. Explant grade >4 was associated with increased HCV-related graft loss at 1 (6% versus 3%) and 5 (36% versus 14%) years post-LT (P = 0.003). On univariate and multivariate Cox regression analysis, predictors of advanced fibrosis were explant grade >4 (hazard ratio [HR] = 3.3, 95% confidence interval [CI] = 1.9-5.6, P < 0.001) donor age >50 (HR = 3.3, 95% CI = 1.9-5.7, P < 0.001) and viral load at LT of >158,730 IU/mL (HR = 1.8, 95% CI = 1.05-3.1, P = 0.03). Conclusion: Explant histologic grade can identify patients requiring more aggressive monitoring and intervention for HCV recurrence post-LT. Liver Transpl 17:685-694, 2011.

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