Introduction: Fibrosing cholestatic hepatitis (FCH) is an aggressive form of hepatitis C which is seen following liver transplantation (OLT) and it carries high mortality rate. Factors associated with development of FCH are not well defined.

Materials and Methods: From Jan 2009 through July 2012, 218 adult patients underwent OLT and 77 (35%) had hepatitis C. 6 (7.8%) patients with recurrent HCV had biopsy proven FCH. Data were collected on donor and recipient characteristics. Immunosupression was protocol based and all but one received tacrolimus. We matched 4 controls per case who were transplanted for HCV over the same time period without FCH. Liver biopsies were performed every 6 -12 months. Analysis was performed using Fisher's exact test and logistic regression.

Results: The mean time to FCH was 20 weeks. Patients who received a gender mismatch organ were 12-fold more likely to develop FCH, OR=12.1 [95%CI 1.2-123], p=0.026. CMV negative patients who received a CMV positive organ were 7.6 times more likely to develop FCH OR=7.6 [95% CI 1.1 -54], p=0.04. After controlling for donor age and steroid treated rejection gender mismatch remained a significant predictor OR=10.6 [95% CI 0.99-118], p=0.05. 5 of the 6 FCH (83%) patients died compared to no deaths in controls. The characteristics of FCH vs. non-FCH groups are shown in the Table.

Conclusions: Gender and CMV mismatch were strong predictors of FCH in HCV recipients following OLT. Post-OLT CMV viremia was associated with FCH. If confirmed, donor gender and CMV status could influence donor selection for hepatitis C recipients and centers may adapt more aggressive prophylaxis against CMV.

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