Recurrence of Hepatitis C virus following liver transplantation is universal.
A subset of these patients develop advanced fibrosis and cirrhosis, and it is believed that this leads to increased posttransplantation mortality.
Dr Mitchell Shiffman and colleagues from Virginia, USA determined the incidence of advanced fibrosis and those factors associated with this process.
The research team evaluated causes for mortality in patients with recurrent Hepatitis C virus.
|41% developed advanced fibrosis 6 to 10 years after liver transplantation|
A total of 227 patients who underwent liver transplantation with chronic Hepatitis C virus were monitored prospectively.
The research team found the mean age of this group at liver transplantation was 50 years, and 76% were male and 85% were Caucasian.
The team monitored fibrosis progression by protocol liver biopsy, initially performed 6 months after liver transplantation and then at 6- to 24-month intervals.
Advanced fibrosis, defined as the bridging fibrosis or cirrhosis, developed in 1%, 11%, 25%, and 41% of patients after 1, 3, 5, and 6 to 10 years, respectively.
Acute cellular rejection hepatic steatosis, a persistent elevation in serum alanine aminotransferase was associated with the development of advanced fibrosis.
The team observed that donor-race was associated with the development of advanced fibrosis.
In contrast, the development of advanced fibrosis was not affected by the use of interferon prior to undergoing liver transplantation, cytomegalovirus disease, or donor age.
The researchers noted that 26% of patients died over the 15 years of follow-up.
Although graft failure accounted for 45% of deaths in patients with advanced fibrosis, this represented only 8% of all deaths in patients with recurrent Hepatitis C.
Sepsis was the most common cause of death.
The team observed sepsis with similar frequency in patients who developed advanced fibrosis, and in those with less advanced fibrosis.
Dr Shiffman's team concluded, "Approximately 41% of patients with recurrent Hepatitis C virus developed advanced fibrosis 6 to 10 years after liver transplantation."
"However, complications associated with sepsis, not recurrent cirrhosis, was the most common cause of death in patients with recurrent Hepatitis C virus."
"This was similar in patients with or without advanced fibrosis."