HCV eradication does not protect from fibrosis progression in patients with fibrosing cholestatic hepatitis after liver transplantation - 05/11/22
, Mylène Sebagh b, Claire Fougerou-Leurent c, Georges-Philippe Pageaux d, Vincent Leroy e, Sylvie Radenne f, Christine Silvain g, Pascal Lebray h, Pauline Houssel-Debry i, Carole Cagnot j, Emilie Rossignol c, Hélène Danjou c, Aurélie Veislinger c, Didier Samuel a, Jean-Charles Duclos-Vallée a, Jérôme Dumortier k, ⁎ Highlights |
• | Fibrosing cholestatic hepatitis is a rare and very severe form of HCV recurrence after liver transplantation. |
• | Prognosis of HCV recurrence after liver transplantation has been dramatically modified because of direct antivirals. |
• | Histological outcome of 17 patients has been studied. |
• | Fibrosis stage worsened in the majority of patients with fibrosing cholestatic hepatitis despite HCV cure. |
Abstract |
Introduction |
Hepatitis C virus (HCV) may recur after liver transplantation (LT) in the severe form of fibrosing cholestatic hepatitis (FCH). The prognosis dramatically improved by the use of direct acting antivirals (DAAs). The aim of the present study was to describe the change in histological features of FCH after virological eradication.
Methods |
From the ANRS CUPILT cohort we included 17 patients who presented FCH and at least two graft biopsies, one before DAA-treatment and one after. A single expert pathologist, blinded for clinical outcome, retrospectively confirmed the diagnosis of FCH and progression of fibrosis.
Results |
Diagnosis of FCH was made after a median [IQR] 6.0 [3.1–11.8] months after LT, and the median interval between diagnosis and onset of treatment was 1.2 [0.7–6.1] months. The rate of viral eradication was 94.1%. The median delay between the pre-treatment and the treatment biopsies was 12.5 [11.1–20.0] months. Between the end of treatment and the second biopsy, the delay was 5.3 [0.6–7.4] months. Fibrosis stage worsened in 10 patients (58.8%); 6 patients had cirrhosis (35.3%). Chronic rejection appeared in 4 (23.5%) patients.
Conclusion |
Our results suggest that, despite viral eradication in patients presenting FCH after LT, fibrosis progression was observed in half of patients. This should encourage monitoring fibrosis progression despite HCV cure.
Le texte complet de cet article est disponible en PDF.Keywords : Liver transplantation, HCV, Recurrence, Fibrosing cholestatic hepatitis, Treatment, Pathology
Abbreviations : ANRS, CUPILT, DAA, FCH, HCV, HIV, IQR, LT, RBV, SVR
Plan
| ☆ | Clinical Trial Identifier: NCT01944527 |
Vol 46 - N° 9
Article 102024- novembre 2022 Retour au numéro
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