Retransplantation for Fibrosing Cholestatic Hepatitis C (FCH): Outcomes in a Series of 9 Cases
Marcela Salomao, Elizabeth C Verna, Roger K Moreira. Columbia University, New York, NY
Background: Fibrosing cholestatic hepatitis C (FCH-C) is thought to be associated with significantly worse outcomes compared to non-FCH recurrent HCV (rHCV) and is considered a contraindication for retransplantation (re-LT) in some centers. We documented the clinicopathologic outcomes of 9 patients who underwent re-LT for FCH-C at our institution.
Design: All HCV+ patients diagnosed with post-LT FCH-C undergoing re-LT between 2002 and 2011 were identified from our database. Diagnostic criteria for FCH included cholestatic disease in the absence of biliary obstruction by cholangiography and at least three of the following four histopathologic criteria: 1- prominent ductular reaction mimicking biliary obstruction; 2- marked hepatocyte swelling with lobular disarray; cholestasis (canalicular and/or intracellular); and periportal sinusoidal fibrosis. Clinical and pathologic outcomes were compared to non-FCH rHCV re-LT patients.
Results: Nine FCH-C (M=6, F=3, age 53±9.4) and 35 non-FCH, rHCV patients (M=23, F=12, age 53.2±8.5) underwent re-LT and were included in this study. Significant mortality was seen in the first 2 years post re-LT in both groups. Although our number of re-LT FCH-C patients was small, no statistically significant outcome differences between the two groups could be identified in our series. Clinicopathologic data for each group are shown in Table 1 and Image 1.
|FCH n=9||rHCV n=35||P value|
|1-year survival post re-LT||44.4%||57.1%||0.26|
|2-year survival post re-LT||33.3%||45.7%||0.27|
|Time to histologic rHCV post-OLT2*||3.63||4.40||0.47|
|Max. rHCV histologic grade (1st year)#||1.43 (0-4)||1.70 (0-3)||0.65|
|HCV-related cholestasis (histologic)||55.5%||17.1%||0.09|
|HCV-related cholestasis (bilirubin)||44.4%||25.7%||0.15|
|FCH post re-LT||11.1%||3%||0.20|
|Peak HCV RNA > 30M copies/Dl||22.2%||25.7%||0.37|