S1004 Month 4 Post-OLT Liver Biopsy Accurately Predicts Subsequent Fibrosis in Those Undergoing Orthotopic Liver Transplantation for HCV-Related Cirrhosis

Abstract

HCVrelated end stage liver disease is the most common indication for OLT in the US. There is evidence that HCV-related fibrosis is accelerated post OLT leading to poorer survival compared to other etiologies. Our AIM was to identify factors in hepatitis C patients undergoing OLT that predict accelerated fibrosis 1 year post OLT. METHODS: Retrospective single center review of patients undergoing OLT due to HCVrelated cirrhosis from 2001 to 2008. Donor variables included age,gender,BMI,race,ETOH use,positive toxicology screen,presence of anti-HCV or anti-HBV, graft steatosis/fibrosis,CMV status,perfusion solution,organ procurement location, cold and warm ischemia time,sodium,creatinine,total bilirubin,aminotransferase levels. Recipient variables included age,race,gender,BMI,post OLT ICU duration,MELD score,prior ETOH abuse, presence of HCC,immunosuppression regimen,HCV genotype/viral load,lack of SVR,CMV status,pre-OLT TIPS,pre-OLT encephalopathy stage III-IV, pre-OLT ascites, post-OLT prolonged mechanical ventilation, post-OLT hypotension requiring pressors,ALT,Alk Phos,TB, ERCP post OLT,hyperglycemia post OLT,creatinine post OLT, rejection episodes, tacrolimus levels, and liver biopsy fibrosis stage scored by Metavir at month 4,and years 1-4 post OLT. Data were analyzed using Chi Square test, Fisher's Exact test and t-tests. The probit-normal model for correlated data and ordinal outcome was used to analyze repeated measures of fibrosis stage as the dependent variable with patient as a random effect. In both sets of analyses, adjustment for year 1 through 4 was also performed and year effect was evaluated.RESULTS: 114 HCV patients (mean ± SEM) age 52 ± 0.3 yrs, BMI 28 ± 0.5, MELD 16 ± 1, 77% male, 87% Caucasian underwent OLT with follow up liver biopsies available for review. Immunosuppression: ATG induction and tacrolimus monotherapy. Only the presence of month 4 fibrosis predicted fibrosis progression during years 1-4 post OLT by probit-normal (estimate 0.911 fibrosis units; p=0.004) and cumulative ordinal logistic regression (estimate 0.864 fibrosis units; p= 0.002). Specific year post OLT was not a predictor of later fibrosis. The interaction between month 4 fibrosis and year fibrosis was not significant. Conclusions:In HCV patients undergoing OLT, month 4 liver biopsy fibrosis level accurately predicts subsequent fibrosis. Those with stage 1-2 fibrosis at month 4 may be candidates for treatment of HCV to prevent further fibrosis progression.