THE PROBLEM OF VIRAL HEPATITIS IN LIVER TRANSPLANTATION

G.J. Mckenna¹, J.F. Trotter², E. Klintmalm³, S. Chinnakotla⁴, N. Onaca¹, R. Ruiz⁵, M.F. Levy¹, R. Goldstein¹, G. Klintmalm^6
1Transplant Services, Baylor Regional Transplant Institute, Dallas/UNITED STATES OF AMERICA, ²Hepatology, Baylor University Medical Center, Dallas/UNITED STATES OF AMERICA, ³, Baylor Regional Transplant Institute, Dallas/TX/UNITED STATES OF AMERICA, ⁴Transplant, Baylor University Medical Center, Dallas/UNITED STATES OF AMERICA, ⁵Transplant Surgery, Baylor University Medical Center, Dallas/UNITED STATES OF AMERICA, ⁶, Baylor University Medical Center, Dallas/UNITED STATES OF AMERICA

Body: Introduction
HCV causes progressive liver fibrosis in liver transplant (OLT) pts and is the main cause of allograft failure. Sirolimus (SRL) antifibrotic effects have been shown in animal models and we recentlypresented data in OLT pts showing that de novo SRL use limits fibrosis progression in liver allografts. However there are no reports on how conversion to SRL impacts established HCV fibrosis. We usethe largest experience of SRL conversion patients to assess the impact of a conversion to SRL immunosuppression on HCV fibrosis after OLT.

Methods
We reviewed 1751 OLT pts from 1998 - 2009 identifying:
a) Cohort of HCV+ pts converted to SRL after 1 year and; b) Control group of HCV+ pts never receiving SRL. Protocol bx were done at year 1 (pre-SRL) and year 2 (post-SRL) recording fibrosis stage(METAVIR score 0-4), and the change in fibrosis stage was compared between the cohort and control. ACR, HAT, CMV and survival were assessed.

Results
A total of 209 HCV+ pts (153 M, 56 F) were converted to SRL at a mean 2.8 yr (range 6 d-16.5 yr) with 16/209 pts converted to SRL at year 1 post OLTx and 13/16 pts (81%) having protocol bx at year 2.All 13 SRL pts (9 M, 4 F) were converted to SRL for CNI nephrotoxicity and none had SRL discontinued. Prior to SRL conversion there was no difference between the groups for either mean fibrosis orpercentage of pts with advanced stage >=2.
Conclusions
Conversion to SRL limits fibrosis progression in HCV and can possibly reduce fibrosis stage in advanced disease. SRL conversion in HCV pts is safe, with no documented HAT, ACR, CMV infection andexcellent post conversion survival. Conversion to SRL represents a potential novel therapy for OLT pts with recurrent HCV.

Disclosure: All authors have declared no conflicts of interest.