Significant liver fibrosis (Scheuer's stage ี 2) and significant portal/periportal necroinflammatory activity (PPA grade ี 2) were observed in 20% and 40% of the cases, respectively. Univariate analysis of variables associated with significant fibrosis and significant activity are summarized in Table 1. Patients with significant fibrosis exhibited longer time after renal transplantation (10.0 ฯฎ 9.4 versus 5.9 ฯฎ 4.5 years, P ฯฝ 0.001). No association between the stage of liver fibrosis and the immunosuppressive regimen used was noted. Conversely, individuals who presented with significant necroinflammatory activity showed longer time after transplantation and less frequent use of CsA. By multiple logistic regression analysis, longer time since renal transplantation (odds ratio ฯญ 1.135, 95% confidence interval 1.025-1.257, P ฯญ 0.015) and non-CsA-based immunosuppression (odds ratio ฯญ 3.438, 95% confidence interval 1.346-8.776, P ฯญ 0.010) were independently associated with significant necroinflammatory activity.
Although the impact of immunosuppressive therapy on HCV RNA titers could not be addressed, we believe that these data provide in vivo evidence that cyclosporine may exert a beneficial effect on necroinflammatory activity of HCV-related liver disease. Additional studies are needed to prospectively assess the influence of CsA on virological parameters (for example, HCV viral load and heterogeneity of quasispecies) in patients with different HCV genotypes. Moreover, it is deemed necessary to further evaluate whether CsA reduces posttransplant HCV-related complications both in renal and liver recipients, as compared with other drugs such as tacrolimus.