Prediction of liver allograft fibrosis after transplantation for hepatitisc virus: Persistent elevation of serum transaminase levels versus necroinflammatory activity

Recurrence of hepatitis C virus (HCV) after orthotopic liver transplantatio n (OLT) remains a significant source of morbidity and mortality. Factors th at reliably predict allograft injury from HCV have not been identified. Dem ographics, clinical data and histopathological characteristics of recipient s with and without persistently elevated serum transaminase levels (PEST) w ere compared Twenty-four patients with HCV-induced end-stage liver disease who underwent OLT between October 1995 and December 1998 were entered into a longitudinal, prospective evaluation for identification of parameters ass ociated with graft injury. Liver biopsies were performed preoperatively and between posttransplantation days 1 to 28, 29 to 60, 61 to 180, 181 to 360, and then every 6 to 12 months thereafter. Biopsy specimens were reviewed i n a blinded fashion and scored for rejection, necroinflammatory activity, e xtent of fibrosis, and infiltrating cell type, location, and magnitude. Tra nsplant recipients with PEST (alanine transaminase level >1.5 times normal for 3 consecutive months) and cholestatic hepatitis showed an increased vit al load compared with their own preoperative values (16-fold and 256-fold, respectively). Compared with control transplant recipients, PEST was associ ated with macrovesicular steatosis within 28 days after OLT (P <.05) and sh owed an increased rate of fibrosis (P <.003) despite similar degrees of rej ection and necroinflammatory activity. There was no difference in demograph ics or immunosuppression. Macrovesicular steatosis may be the earliest pred ictor of graft fibrosis. Despite similar degrees of necroinflammatory activ ity, transplant recipients with PEST had an increased rate of fibrosis that could be predicted on average within 6 months posttransplantation. Copyrig ht (C) 2000 by the American Association for the Study of liver Diseases.