Post-transplantation recurrence is increasing in patients with HCV. Therefore, early antiviral therapy may be beneficial in this setting.
Accurate and early prediction of disease progression may help to select candidates for this treatment.
In this study, researchers from Spain and the United States developed a model based on pre- and post-transplantation variables. The team aimed to predict progression to severe disease.
The research team assessed the clinical and histologic outcomes of 554 liver recipients.
| Risk of progressing to fibrosis 3 and 4 is greater in recently transplanted patients.|
They scored 1353 biopsy specimens obtained after 1 year.
The team used 2 outcome measures. These were cumulative probability of developing severe disease (fibrosis 3 and 4) within 5 years, and actual progression to severe disease in 2 years.
They analyzed the cohort using Cox proportional hazard survival analysis. Predictors analyzed included HCV genotype and recipient, donor, and transplant-related variables.
The team found that the cumulative risk of progressing to fibrosis 3 and 4 was significantly greater in patients transplanted recently.
The factors which increased this risk were found to be genotype, induction with mycophenolate, donor age, short course of azathioprine, and prednisone.
In order to create a model of prediction, the team analyzed 285 patients with 2-year follow-up using a logistic regression analysis.
They determined that the probability of being at high risk for severe disease was calculated from a formula that included donor age and recipient therapy as critical variables.
Dr Marina Berenguer's team concluded, "We have developed a model that uses early post-transplantation variables to predict severe HCV recurrence".
"Accuracy of the model is not perfect (c-statistic 0.80), probably reflecting the complexity of HCV in the liver transplant setting".