Hepatic steatosis at 1 year is an additional predictor of subsequent fibrosis severity in liver transplant recipients with recurrent hepatitis C virus
✍ Scribed by Danielle Brandman; Andrea Pingitore; Jennifer C. Lai; John P. Roberts; Linda Ferrell; Nathan M. Bass; Norah A. Terrault
- Publisher
- John Wiley and Sons
- Year
- 2011
- Tongue
- English
- Weight
- 139 KB
- Volume
- 17
- Category
- Article
- ISSN
- 1527-6465
- DOI
- 10.1002/lt.22389
No coin nor oath required. For personal study only.
✦ Synopsis
Recurrent hepatitis C virus (HCV) is the most common cause of graft loss for HCV-infected recipients of liver transplantation (LT). Diabetes mellitus (DM) has been associated with increased rates of fibrosis progression, but whether steatosis affects post-LT outcomes independently of DM is unclear. Using a retrospective cohort of HCV-infected LT recipients, we determined the prevalence of hepatic steatosis and evaluated the relationship between steatosis on index biopsy 1 year after LT (66 months) and the severity of the subsequent fibrosis. One hundred fifty-two LT recipients with HCV were followed up for a median of 2.09 years (range ¼ 0.13-6.17 years) after index biopsy; the median number of biopsy procedures per patient after index biopsy was 2 (range ¼ 1-6). Steatosis (5%) was present in 45 individuals (29.6%) according to index biopsy samples taken 1 year after LT; the steatosis was mild (grade 1) in 80% of the patients. In the multivariate analysis, the presence of steatosis 1 year after LT was positively associated with HCV genotype 3 [odds ratio (OR) ¼ 3.60, P ¼ 0.02], older donor age (OR ¼ 1.03, P ¼ 0.04), and pre-LT hypertension (OR ¼ 3.29, P ¼ 0.009). Two years after index biopsy, the cumulative rate of significant fibrosis (F2-F4 on the Ludwig-Batts scale) was 49% in the patients with steatosis at 1 year and 24% in the patients without steatosis (P ¼ 0.003). In the multivariate analysis, steatosis at 1 year was an independent predictor of subsequent F2 to F4 fibrosis (HR ¼ 2.63, 95% CI ¼ 1.49-4.63). Steatosis was a stronger predictor of fibrosis in the setting of sirolimus use (hazard ratio ¼ 9.38, 95% confidence interval ¼ 1.37-64.16, P ¼ 0.02). In conclusion, steatosis is frequent in the early post-LT period, and steatosis within the first year after LT is a marker of a higher risk of fibrosis progression in HCV-infected patients.