Abstract
Background
Preservation injury in the HCV liver transplant population has been reported to correlate with poorer survival outcomes compared to preservation injury in the non-HCV liver transplant population. However, determinants of progression to cirrhosis in HCV infection remain poorly defined in this population.
Aim
This study aimed to determine if the presence and severity of preservation injury impact the acceleration of HCV recurrence and survival after liver transplant.
Methods
We retrospectively reviewed liver transplant HCV patients over a 10-year period. Biopsies from postoperative day 7 were assessed for preservation injury and 4- and 12-month biopsies were assessed for fibrosis. Patients with Ishak fibrosis >0.8 Units/year were considered rapid fibrosers.
Results
Our study group consisted of 255 patients. The mean age was 49.3 years old, 180 (70.6 %) were male, and 221 (86.7 %) were Caucasian. The incidence of preservation injury on the 7-day biopsy was 69.0 %. A strong correlation between postoperative peak AST within the first week and preservation injury was found. The overall prevalence of rapid fibrosers at 4 months, 1 and 2 years was 47.4, 75.2, and 58.9 %, respectively. The prevalence of rapid fibrosers at 4 months, 1 and 2 years between patients with or without preservation injury was not statistically significant (p = 0.39, p = 0.46, and p = 0.53, respectively). No differences were seen between patients with and without PI in terms of patient and graft survival.
Conclusion
In this study, the presence and severity of preservation injury were not associated with development of rapid HCV recurrence or worsening in survival.
Similar content being viewed by others
References
Armstrong GL, Wasley A, Simard EP, McQuillan GM, Kuhnert WL, Alter MJ. The prevalence of hepatitis C virus infection in the United States, 1999 through 2002. Ann Intern Med. 2006;144:705–714.
Wasley A, Alter MJ. Epidemiology of hepatitis C: geographic differences and temporal trends. Semin Liver Dis. 2000;20:1–16.
Verna EC, Brown RS Jr. Hepatitis C and liver transplantation: enhancing outcomes and should patients be retransplanted. Clin Liver Dis. 2008;12:637–659.
Charlton M, Seaberg E, Wiesner R, et al. Predictors of patient and graft survival following liver transplantation for hepatitis C. Hepatology. 1991;28:823–830.
Gallegos-Orozco JF, Yosephy A, Noble B, et al. Natural history of post-liver transplantation hepatitis C: a review of factors that may influence its course. Liver Transpl. 2009;15:1872–1881.
Ghobrial RM, Steadman R, Gornbein J, et al. A 10-year experience of liver transplantation for hepatitis C: analysis of factors determining outcome in over 500 patients. Ann Surg. 2001;234:384–393.
Manez R, Mateo R, Tabasco J, Kusne S, Starzl TE, Duquesnoy RJ. The influence of HLA donor-recipient compatibility on the recurrence of HBV and HCV hepatitis after liver transplantation. Transplantation. 1995;59:640–642.
Manousou P, Samonakis D, Cholongitas E, et al. Outcome of recurrent hepatitis C virus after liver transplantation in a randomized trial of tacrolimus monotherapy versus triple therapy. Liver Transpl. 2009;15:1783–1791.
Rosen HR, Chou S, Corless CL, et al. Cytomegalovirus viremia: risk factor for allograft cirrhosis after liver transplantation for hepatitis C. Transplantation. 1997;64:721–726.
Velidedeoglu E, Mange KC, Frank A, et al. Factors differentially correlated with the outcome of liver transplantation in hcv+ and HCV− recipients. Transplantation. 2004;77:1834–1842.
Watt KD, Lyden ER, Gulizia JM, McCashland TM. Recurrent hepatitis C posttransplant: early preservation injury may predict poor outcome. Liver Transpl. 2006;12:134–139.
Lee YM, O’Brien CB, Yamashiki N, et al. Preservation injury patterns in liver transplantation associated with poor prognosis. Transplant Proc. 2003;35:2964–2966.
Tillery W, Demetris J, Watkins D, et al. Pathologic recognition of preservation injury in hepatic allografts with six months follow-up. Transplant Proc. 1989;21:1330–1331.
Baron PW, Sindram D, Higdon D, et al. Prolonged rewarming time during allograft implantation predisposes to recurrent hepatitis C infection after liver transplantation. Liver Transpl. 2000;6:407–412.
Camargo CA Jr, Madden JF, Gao W, Selvan RS, Clavien PA. Interleukin-6 protects liver against warm ischemia/reperfusion injury and promotes hepatocyte proliferation in the rodent. Hepatology. 1997;26:1513–1520.
Selzner M, Camargo CA, Clavien PA. Ischemia impairs liver regeneration after major tissue loss in rodents: protective effects of interleukin-6. Hepatology. 1999;30:469–475.
Brokelman W, Stel AL, Ploeg RJ. Risk factors for primary dysfunction after liver transplantation in the University of Wisconsin solution era. Transplant Proc. 1999;31:2087–2090.
Busquets J, Figueras J, Serrano T, et al. Postreperfusion biopsies are useful in predicting complications after liver transplantation. Liver Transpl. 2001;7:432–435.
Ploeg RJ, D’Alessandro AM, Knechtle SJ, et al. Risk factors for primary dysfunction after liver transplantation—a multivariate analysis. Transplantation. 1993;55:807–813.
Firpi RJ, Abdelmalek MF, Soldevila-Pico C, et al. One-year protocol liver biopsy can stratify fibrosis progression in liver transplant recipients with recurrent hepatitis C infection. Liver Transpl. 1991;10:1240–1247.
Ishak K, Baptista A, Bianchi L, et al. Histological grading and staging of chronic hepatitis. J Hepatol. 1991;22:696–699.
Killackey MT, Gondolesi GE, Liu LU, et al. Effect of ischemia-reperfusion on the incidence of acute cellular rejection and timing of histologic hepatitis C virus recurrence after liver transplantation. Transplant Proc. 2008;40:1504–1510.
Shackleton CR, Martin P, Melinek J, et al. Lack of correlation between the magnitude of preservation injury and the incidence of acute rejection, need for OKT3, and conversion to FK506 in cyclosporine-treated primary liver allograft recipients. Transplantation. 1995;60:554–558.
Briceno J, Marchal T, Padillo J, Solorzano G, Pera C. Influence of marginal donors on liver preservation injury. Transplantation. 2002;74:522–526.
Boker KH, Dalley G, Bahr MJ, et al. Long-term outcome of hepatitis C virus infection after liver transplantation. Hepatology. 1997;25:203–210.
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Additional information
The project described was supported by the Clinical and Translational Science Award (CTSA) program (D.P.F.), through the NIH National Center for Advancing Translational Sciences (NCATS), grant UL1TR000427. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
Rights and permissions
About this article
Cite this article
Michaels, A.J., Dhanasekaran, R., Foley, D.P. et al. Hepatic Preservation Injury: Severity of Hepatitis C Recurrence and Survival After Liver Transplantation. Dig Dis Sci 58, 1403–1409 (2013). https://doi.org/10.1007/s10620-012-2521-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10620-012-2521-9