Liver stiffness identifies two different patterns of fibrosis progression in patients with hepatitis C virus recurrence after liver transplantation

Abstract

Significant liver fibrosis (F > 2) and portal hypertension (hepatic venous pressure gradient[HVPG] > 6 mmHg) at 1 year after liver transplantation (LT) identify patients with severe hepatitis C recurrence. We evaluated whether repeated liver stiffness measurements (LSM) following LT can discriminate between slow and rapid "fibrosers" (fibrosis stage F2-F4 at 1 year after LT). Eighty-four patients who had undergone LT and who were infected with hepatitis C virus (HCV) and 19 LT controls who were not infected with HCV underwent LSM at 3, 6, 9, and 12 months after LT. All HCV-infected patients underwent liver biopsy 12 months after LT (paired HVPG measurements in 74); 31 (37%) were rapid fibrosers. Median LSM (in kilopascal) at months 6, 9, and 12 were significantly higher in rapid fibrosers (9.9, 9.5, 12.1) than in slow fibrosers (6.9, 7.5, 6.6) (P < 0.01 all time points). The slope of liver stiffness progression (kPa ؋ month) in rapid fibrosers (0.42) was significantly greater than in slow fibrosers (0.05) (P < 0.001), suggesting two different speeds of liver fibrosis progression. H epatitis C virus (HCV) infection recurs universally after liver transplantation (LT) 1 and graft cirrhosis develops in a significant proportion of patients within the first years after LT. 2-4 As a result of this accelerated course, hepatitis C recurrence is the first cause of graft loss and reduction in patient survival in most liver transplant programs. 5 Thus, identification of patients at risk of severe recurrence at an early stage, in order to adopt therapeutic decisions, 6-8 becomes crucial. It is well known that early histological damage after transplantation corre-

Non-invasive assessment of liver fibrosis in chronic hepatitis C

“…However, liver stiffness measurement (LSM) cannot yet confidently predict the presence of esophageal varices in clinical practice and thus avoid the need for upper GI endoscopic screening of cirrhotic patients [85]. TE could be also valuable for assessing the severity of recurrent hepatitis C after liver transplantation, reducing the need for follow-up liver biopsies [78,[86][87][88][89][90]. It has been recently suggested that TE may perform better for significant fibrosis than serum (direct and indirect) biomarkers [91].…”

Liver Stiffness 1 Year After Transplantation Predicts Clinical Outcomes in Patients With Recurrent Hepatitis C

“…Similarly, LSM has proven to be useful to assess histological progression after transplantation (13,14). However, to date, no study has evaluated the association between liver stiffness and clinical events, including graft and patient survival, in recurrent hepatitis C following LT. Only a score comprising three direct serum biomarkers proved helpful to predict the development of clinical decompensations and graft loss in this setting (15), though these markers have not been validated so far.…”

Liver Stiffness, a Non-Invasive Marker of Liver Disease: A Core Study Group Report

“…The evidence that FS accurately predicted non-HCV-related graft damage suggests an extended application of FS in the management of non-HCV-infected LT patients to help decision making for LB. The usefulness of LS in the management of LT patients has been recently confirmed by longitudinal data provided by Carrión et al [47].…”