Comparative allograft histology after liver transplantation for cryptogenic cirrhosis, alcohol, hepatitis C, and cholestatic liver diseases

Background. End-stage liver disease for which no cause can be identified, c ryptogenic cirrhosis, is a common indication for liver transplantation. All ograft inflammation and fibrosis have been reported to recur with similar f requencies after liver transplantation for cryptogenic cirrhosis and hepati tis C (HCV). Methods. We determined sequential posttransplant allograft histology in fou r groups of recipients: 31 transplanted for cryptogenic cirrhosis, 70 for c holestatic etiologies, 40 for alcoholic liver disease, and 56 for HCV, Modi fied hepatitis activity index (HAI) and fibrosis stage were determined at 4 months, 1 year, and at most recent biopsy posttransplantation. Results. The prevalence of HAI greater than or equal to 2 among cryptogenic recipients was similar to that of cholestatic and alcoholic recipients at 4 months, 1 year, and at most recent evaluation (mean 45+/-17 months posttr ansplantation). For HCV-infected recipients, the frequency of HAI greater t han or equal to 2 was more than for cryptogenic recipients at 1 year (52 vs . 29%, P=0.04) and at most recent evaluation (64 vs. 15%, P=0.003). Fibrosi s scores for cryptogenic, cholestatic and alcoholic recipients were similar at all timepoints, The proportion of HCV-infected recipients with fibrosis stage >2 was more than that of cryptogenic recipients at 4 months (29 vs. 12%, P=0.05), 1 years (46 vs. 7% P=0.0002), and at most recent evaluation ( 42 vs, 15%, P=0.06), None of the cryptogenic recipients developed cirrhosis . Results. The frequency of elevated BAI and fibrosis stage in recipients who undergo transplantation for cryptogenic cirrhosis is similar to that of re cipients who undergo transplantation for cholestatic etiologies and signifi cantly less than that of HCV-infected recipients. Fibrosis stage and HAI ar e generally stable after transplantation for cryptogenic cirrhosis, These d ata do not suggest a viral etiology of liver disease in the majority of pat ients with cryptogenic cirrhosis.