Clinicopathologic Features in Earlier Interim Liver Allograft Biopsies May Predict Recurrent Hepatitis C-Associated Fibrosis Progression
MR Stitzel, AM Larson, MM Yeh. University of Washington Medical Center, Seattle, WA
Background: The progression rate of recurrent hepatitis C virus (HCV)-associated fibrosis in liver allografts post orthotopic liver transplant (OLT) varies, in which the roles of both viral and host factors have been suggested. We studied the histologic features in interim (IT) allograft biopsies that subsequently developed early fibrosis progression due to recurrent HCV.
Design: Cases of OLT performed for HCV cirrhosis at a major liver transplant center during 2001-2008 were retrospectively reviewed. All recurrent HCV biopsies (bx) developing at least Batts/Ludwig (BL) stage 2 fibrosis within 4 years as progressors (PR) and those developing no or only stage 1 fibrosis in a similar time period (endpoint: EP) as non-progressors (NP) were included. Earlier IT bx within 15 months post OLT in PR and those in a similar period in NP when available were reviewed. After cases not meeting inclusion criteria and cases with rejection/complications were excluded, 32 PR and 22 NP remained. Histologic features including BL grade/stage, Ishak scores, acidophil body index (ABI: total acidophil body count/mm2), steatosis, and cholestasis were assessed at the consensus of two authors blinded to fibrosis progression status and lab data.
Median or mean(*) histologic parameters in interim biopsies
|ABI*||BL Grade||BL Stage||Ishak Portal Inflammation||Ishak Periportal Injury*||Ishak Parenchymal Injury||Ishak Fibrosis|
There was no significant difference in age, gender, and race between PR and NP. Mean duration from OLT to EP bx in PR and NP was 24 and 40 months, respectively (p=0.02) and from OLT to IT bx was 10 and 20 months, respectively (p=0.07). ABI, BL grade/stage, and Ishak scores of various inflammation/fibrosis parameters of IT bx were significantly higher in PR vs NP (Table); there was no significant difference in steatosis and cholestasis. Liver function tests (LFT), including ALP, ALT, AST, and GGT were also higher in PR vs NP at time of IT bx (p: all<0.05).
Conclusions: Our findings suggest that acidophil body index, BL grade/stage, and Ishak scores in interim bx (10-20 months), along with LFT may predict subsequent progression of recurrent HCV-associated fibrosis. Large cohort and/or prospective studies are warranted to validate these observations.
Category: Liver & Pancreas
Monday, March 9, 2009 9:30 AM
Poster Session I Stowell-Orbison/Autopsy Award # 214, Monday Morning