Predictors of Fibrosing Cholestatic Hepatitis Development Following Liver Transplantation: Potential Impact on Donor Selection and CMV Prophylaxis
Center for Liver Diseases, Carolinas Medical Center, Charlotte, NC
Meeting: 2013 American Transplant Congress
Abstract number: D1775
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.
FCH (n=6) | Non-FCH (n=24) | P Values | |
Recipient age | 55 | 55 | |
Male | 5 | 23 | |
MELD | 22 | 19 | 0.55 |
PreOLT Mean HCV viral load IU/ml | 1,827,971 | 866,955 | 0.14 |
Genotype 1 | 6 (100%) | 24 (100%) | |
Mean donor age (years-old) | 41 | 34 | 0.16 |
Treated for rejection (%) | 1 (16%) | 5 (21%) | 1 |
Gender mismatch | 5 (83%) | 7 (29%) | 0.029 |
Donor CMV+/Recipient CMV- | 4 (66%) | 5 (21%) | 0.049 |
CMV viremia post OLT | 6 (100%) | 6 (25%) | 0.002 |
Gender & CMV mismatch | 3 (50%) | 0 | 0.005 |
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.
To cite this abstract in AMA style:
Yazici C, Jacobs C, Ahrens W, Zamor P, Schmeltzer P, Casingal V, Eskind L, Levi D, Hayes D, Russo M. Predictors of Fibrosing Cholestatic Hepatitis Development Following Liver Transplantation: Potential Impact on Donor Selection and CMV Prophylaxis [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/predictors-of-fibrosing-cholestatic-hepatitis-development-following-liver-transplantation-potential-impact-on-donor-selection-and-cmv-prophylaxis/. Accessed December 2, 2024.« Back to 2013 American Transplant Congress