THE PROBLEM OF VIRAL HEPATITIS IN LIVER TRANSPLANTATION

S. Chinnakotla¹, G.L. Davis², J.F. Trotter³, H. Randall¹, G.J. Mckenna⁴, R. Ruiz⁵, N. Onaca⁴, M. Asolati⁶, P. Kim¹, K. Tomiyama¹, K. Cavaness¹, B. Yildiz¹, L. Jennings¹, M.F. Levy⁷, R. Goldstein¹, G. Klintmalm^8
1Transplant, Baylor University Medical Center, Dallas/TX/UNITED STATES OF AMERICA, ²Hepatology, Baylor University Medical Center, Dallas/UNITED STATES OF AMERICA, ³Hepatology, Baylor University Medical Center, Dallas/TX/UNITED STATES OF AMERICA, ⁴Transplant Services, Baylor Regional Transplant Institute, Dallas/TX/UNITED STATES OF AMERICA, ⁵Transplant Surgery, Baylor University Medical Center, Dallas/UNITED STATES OF AMERICA, ⁶Transplant Surgery, Baylor University Medical Center, Dallas/TX/UNITED STATES OF AMERICA, ⁷Transplant Services, Baylor Regional Transplant Institute, Dallas/UNITED STATES OF AMERICA, ⁸, Baylor University Medical Center, Dallas/UNITED STATES OF AMERICA

Body: Introduction: There are few studies evaluating risk factors associated with histological progression of inflammation and fibrosis in posttransplant recurrence of hepatitis C as determined by liver biopsy stage and grade. Methods: We evaluated 341 patients who received liver transplants for hepatitis C-related cirrhosis from 2002 to 2008 and had a minimum of 1-year follow-up with annual protocol biopsies. A total of 1511 biopsies were reviewed. The stage of fibrosis and inflammation were graded from 1-4. Progression to Grade 2 and Stage 3 were considered significant recurrence. Results: Univariate analysis of 15 possible factors affecting recurrence showed that donor age >50 years (p=0.561), female gender (p= 0.0027), African American race (p= 0.0001), steroid-resistant rejection (p= 0.0265) and use of MMF (p= 0.0406) were associated with significant progression of fibrosis. Female gender (p= 0.0215), African Americans race (p=0.0006), presence of one or more rejection episodes within 1-year posttransplant (p= <0.0009) and steroid-resistant rejections (p=0.0009) were associated with Grade 2 recurrence. Multivariate analysis showed that African American race [p=0.004, HR 2.7; CI 1.6-4.7], more than one episode or acute rejection within 1-year posttransplant [p=0.0033, HR 2.7; CI 1.4-5.3] were associated with progression of fibrosis (Figure 1); the same two factors African American race [p=0.0365; HR 1.6; CI1-2.6], acute rejection [p<0.0001; HR 3.0; CI 1.8-5.2] (Figure 2) were also associated with significant progression of inflammation. Conclusion: More than one episode of acute rejection, female gender and African American race are significantly associated with histological progression of hepatitis C following liver transplantation.

Disclosure: All authors have declared no conflicts of interest.