A research team from the Royal Free Hospital in London, England, evaluated the histological outcome of post-translational HCV infection with respect to initial immunosuppressive therapy.
Their study was carried out in a cohort of 59 HCV-positive patients who survived at least 12 months.
Within the study, 41 patients were administered initial triple immunosuppressive therapy involving cyclosporine or tacrolimus, as well as azathioprine and prednisolone.
5 patients received a double combination therapy of cyclosporine and prednisolone.
13 patients received either cyclosporine or tracrolimus only.
Assessment, by blinded histological evaluation, measured necroinflammatory activity (grading score: 0-18) and fibrosis (staging score: 0-6). The median histological follow-up was 36 months.
High necroinflammatory activity (grading score 4) - indicating chronic hepatitis - was identified in the final liver biopsies of 42 (71%) patients. Some 18 subjects (30.5%) were found to be suffering from severe fibrosis or cirrhosis (staging score 4).
There was a significant association between high necroinflammatory activity and absence of pre-transplant alcohol abuse, and also with occurrence of post-transplant acute lobular hepatitis C.
Development of severe fibrosis or cirrhosis was significantly associated only with the type of initial immunosuppressive therapy.
|30% of HCV transplant patients develop fibrosis or cirrhosis.|
In particular, severe fibrosis or cirrhosis developed more frequently in patients treated with triple or double (37%), than with single initial immunosuppressive therapy (8%), once adjustments had been made for biopsy time.
George V. Papatheodoridis, concluded on behalf of his fellow authors that, "Severe fibrosis or cirrhosis appears to develop in 30% of HCV transplant patients. This occurs in a median of 3 years and seems to be associated with heavier initial immunosuppression."