Impact of Donor Liver Steatosis/Fibrosis Progression on Allograft Outcome in a Cohort of 203 Post Transplant Recurrent Hepatitis C Patients
M Ramineni, M Moeller, K Brown, V Shah. Henry Ford Hospital, Detroit, MI
Background: Recurrent hepatitis C after liver transplantation progresses faster than hepatitis C in non-transplant settings. Factors such as steatosis and fibrosis are well established in contributing towards worsening of transplant outcome. The aim of this study was to determine the influence of donor graft steatosis and fibrosis progression (FP) on overall outcome in patients who received orthotopic liver transplant for hepatitis C virus induced cirrhosis.
Design: 268 patients were diagnosed with post transplant recurrent hepatitis C from 1999 - 2006 in our institution. 203 patients did not receive any therapy and constituted the cohort for this study to assess the natural progression of steatosis and fibrosis. Pathology records and biopsy slides were reviewed of the 54 patients who developed steatosis/fibrosis (SF group). Donor steatosis was graded as none=1, 0- 5%= 2, 5- 25%=3, 26- 50%= 4, 51- 75%= 5 and 76- 100%= 6. Fibrosis was graded per Metavir scoring as F0= no fibrosis, F1= Portal Fibrosis (PF) without septa, F2= PF with few septa, F3= bridging fibrosis without cirrhosis, F4= cirrhosis. FP rate was calculated in terms of Fibrosis Units (FU): Change in Metavir fibrosis stage/post transplant duration in years. Data was analyzed for allograft failure and retransplantation.
Results: Of the 54 patients in the S/F group, 16(29%) had bridging fibrosis/cirrhosis, 21(39%) had steatosis, 17 had steatosis and fibrosis (32%). The average FP for most patients at their first biopsy was 2.5 FU/year and the average steatosis was 25%. During their last available biopsy most patients had an average FP of 4.2 FU/year and an average steatosis of 15% . Allograft failed in 24 (44%) patients in the S/F group with re-transplantation in 12(22%) patients. Of the re-transplant patients, 5(42%) died in less than 1 year. 7(58%) are surviving after a followup of 2 yrs. Of the 146 patients who were not in the S/F group, 75% of the patients have recurrent hepatitis C with a mean survival of 5.1 years. 16(10%) needed re-transplantation and 48 (32%) died in 3yrs.
Conclusions: 1. The allograft failure related deaths in the S/F group is 1.3 times higher than the non S/F group. 2. The allograft failure in the re-transplant livers accelerated twice faster in patients in the S/F group compared to patients in the non-S/F group. 3. The average fibrosis progression per year (FU=2.5) in recurrent hepatitis C patients in the S/F group is significantly higher than the chronic hepatitis group published in the literature (FU=0.25).
Category: Liver & Pancreas
Tuesday, March 23, 2010 9:30 AM
Poster Session III # 239, Tuesday Morning