Impact of fibrosis progression on clinical outcome in patients treated for post- transplant hepatitis C recurrence

Renumathy Dhanasekaran, William Sanchez, Taofic Mounajjed, Russell H. Wiesner, Kymberly D. Watt, Michael R. Charlton

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12 Scopus citations

Abstract

Background and Aims: Patients who achieve sustained virological response (SVR) following the treatment of post-liver transplant (LT) recurrence of hepatitis C virus (HCV) infection have improved outcomes. The full impact of eradication of HCV on allograft histology is, however, not clearly known. Methods: We studied allograft histology in protocol-based paired liver biopsies in consecutive LT recipients who underwent post-LT treatment of recurrence of HCV. Results: A total of 116 patients were treated with interferon-based therapy for recurrent HCV. Paired pre-treatment baseline biopsies and post-treatment biopsies were available in 83.2% of patients. SVR was achieved in 37.9% of patients. Among the patients who achieved SVR, 20.5% had progression of fibrosis on post-treatment biopsies vs. 65.5% of patients with non-response/relapse (P <0.001). The impact of virological response on fibrosis progression was sustained and a similar outcome was observed in the subset of patients who had 4-5 year post-treatment biopsies available. In the SVR group, 12.8% progressed to fibrosis stage ≥3 on post-treatment biopsies vs. 37.9% in the non-response/relapse group (P = 0.001). The 5-year survival in patients with progression of fibrosis 86% vs. 98% among patients who had improvement/stable fibrosis [P = 0.003; HR 3.8 (1.2-11.8)]. A small subset of patients who achieve SVR unfortunately still experience progression of fibrosis, most commonly associated with plasma cell hepatitis. Conclusions: In post-transplant patients treated for HCV, SVR is associated with improved graft survival and also with sustained and significant improvement in histological outcome. Importantly, progression of fibrosis still occurred in a small subset of patients who achieved SVR. See Editorial on Page 2354

Original languageEnglish (US)
Pages (from-to)2433-2441
Number of pages9
JournalLiver International
Volume35
Issue number11
DOIs
StatePublished - Nov 1 2015

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Keywords

  • Fibrosis
  • Hepatitis C
  • Paired biopsy
  • Survival
  • Treatment

ASJC Scopus subject areas

  • Hepatology

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