A prospective evaluation of fibrosis progression in patients with recurrent hepatitis C virus following liver transplantation

Nevin Yilmaz, Mitchell L. Shiffman, R. Todd Stravitz, Richard K. Sterling, Vellmir A. Luketic, Arun J. Sanyal, A. Scott Mills, Melissa J. Contos, Adrian Coterell, Daniel Maluf, Marc P. Posner, Robert A. Fisher

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Abstract

Recurrence of hepatitis C virus (HCV) following liver transplantation (LT) is universal. A subset of these patients develop advanced fibrosis and cirrhosis and it is believed that this leads to increased posttransplantation mortality. The specific aims of this study were to determine the incidence of advanced fibrosis and those factors associated with this process, and to evaluate causes for mortality in patients with recurrent HCV. A total of 227 patients who underwent LT with chronic HCV were monitored prospectively. The mean age of this group at LT was 49.5 yr; 76% were male and 85% were Caucasian. Fibrosis progression was monitored by protocol liver biopsy, initially performed 6 months after LT 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 6-10 yr, respectively. Acute cellular rejection hepatic steatosis, a persistent elevation in serum alanine aminotransferase and donor-race were 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 LT, cytomegalovirus disease, or donor age. A total of 60 patients (26%) died over 15 yr 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 HCV. Sepsis was the most common cause of death and this was observed with similar frequency in patients who developed advanced fibrosis (45%) and in those with less advanced fibrosis (47%). In conclusion, approximately 41% of patients with recurrent HCV developed advanced fibrosis 6-10 yr after LT. However, complications associated with sepsis, not recurrent cirrhosis, was the most common cause of death in patients with recurrent HCV and this was similar in patients with or without advanced fibrosis.

Original languageEnglish (US)
Pages (from-to)975-983
Number of pages9
JournalLiver Transplantation
Volume13
Issue number7
DOIs
StatePublished - Jul 1 2007

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Hepacivirus
Liver Transplantation
Fibrosis
Cause of Death
Sepsis
Tissue Donors
Mortality
Liver
Chronic Hepatitis C
Alanine Transaminase
Cytomegalovirus
Interferons
Age Groups

All Science Journal Classification (ASJC) codes

  • Surgery
  • Hepatology
  • Transplantation

Cite this

Yilmaz, N., Shiffman, M. L., Stravitz, R. T., Sterling, R. K., Luketic, V. A., Sanyal, A. J., ... Fisher, R. A. (2007). A prospective evaluation of fibrosis progression in patients with recurrent hepatitis C virus following liver transplantation. Liver Transplantation, 13(7), 975-983. https://doi.org/10.1002/lt.21117

A prospective evaluation of fibrosis progression in patients with recurrent hepatitis C virus following liver transplantation. / Yilmaz, Nevin; Shiffman, Mitchell L.; Stravitz, R. Todd; Sterling, Richard K.; Luketic, Vellmir A.; Sanyal, Arun J.; Mills, A. Scott; Contos, Melissa J.; Coterell, Adrian; Maluf, Daniel; Posner, Marc P.; Fisher, Robert A.

In: Liver Transplantation, Vol. 13, No. 7, 01.07.2007, p. 975-983.

Research output: Contribution to journalArticle

Yilmaz, N, Shiffman, ML, Stravitz, RT, Sterling, RK, Luketic, VA, Sanyal, AJ, Mills, AS, Contos, MJ, Coterell, A, Maluf, D, Posner, MP & Fisher, RA 2007, 'A prospective evaluation of fibrosis progression in patients with recurrent hepatitis C virus following liver transplantation', Liver Transplantation, vol. 13, no. 7, pp. 975-983. https://doi.org/10.1002/lt.21117
Yilmaz, Nevin ; Shiffman, Mitchell L. ; Stravitz, R. Todd ; Sterling, Richard K. ; Luketic, Vellmir A. ; Sanyal, Arun J. ; Mills, A. Scott ; Contos, Melissa J. ; Coterell, Adrian ; Maluf, Daniel ; Posner, Marc P. ; Fisher, Robert A. / A prospective evaluation of fibrosis progression in patients with recurrent hepatitis C virus following liver transplantation. In: Liver Transplantation. 2007 ; Vol. 13, No. 7. pp. 975-983.
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abstract = "Recurrence of hepatitis C virus (HCV) following liver transplantation (LT) is universal. A subset of these patients develop advanced fibrosis and cirrhosis and it is believed that this leads to increased posttransplantation mortality. The specific aims of this study were to determine the incidence of advanced fibrosis and those factors associated with this process, and to evaluate causes for mortality in patients with recurrent HCV. A total of 227 patients who underwent LT with chronic HCV were monitored prospectively. The mean age of this group at LT was 49.5 yr; 76{\%} were male and 85{\%} were Caucasian. Fibrosis progression was monitored by protocol liver biopsy, initially performed 6 months after LT 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 6-10 yr, respectively. Acute cellular rejection hepatic steatosis, a persistent elevation in serum alanine aminotransferase and donor-race were 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 LT, cytomegalovirus disease, or donor age. A total of 60 patients (26{\%}) died over 15 yr 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 HCV. Sepsis was the most common cause of death and this was observed with similar frequency in patients who developed advanced fibrosis (45{\%}) and in those with less advanced fibrosis (47{\%}). In conclusion, approximately 41{\%} of patients with recurrent HCV developed advanced fibrosis 6-10 yr after LT. However, complications associated with sepsis, not recurrent cirrhosis, was the most common cause of death in patients with recurrent HCV and this was similar in patients with or without advanced fibrosis.",
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