- Email: [email protected]
528 IMPROVEMENT OF SURVIVAL IN 24 MONTHS OF PATIENTS IN LIVER TRANSPLANT LIST AFTER THE INTRODUCTION OF MELD IN BRAZIL
POSTERS 526 DIAGNOSTIC PERFORMANCE OF TRANSIENT ELASTOGRAPHY IN THE ASSESSMENT OF SIGNIFICANT LIVER FIBROSIS IN PEDIATRIC LIVER TRANSPLANTATION T. Vinciguerra1 , P.L. Calvo1 , G. Carbonaro1 , F. Baio2 , A. Brunati2 , C. Barbera1 , M. Salizzoni2 . 1 Department of Pediatric Gastroenterology, University of Torino, Regina Margherita Hospital, 2 Liver Transplantation Center, University of Torino, San Giovanni Battista Hospital, Turin, Italy E-mail: [email protected] Background and Aim: Liver fibrosis is an important factor affecting organ survival in transplanted patients, but liver biopsy is an invasive technique to use in children without clinical or serological signs of graft damage. Transient elastography (TE) is a new noninvasive technique, validated in adults, that estimates the liver stiffness of a cylindrical section that is 100 fold that of a standard bioptic specimen. We evaluated the feasibility of TE in children after liver transplantation (LT) and we compared it with liver biopsy. Methods: 24 HCV/HBV negative paediatric liver transplant recipients with reliable TE (IQR <30% and success rate >60%) were enrolled in the study. All patients had TE and biopsy within a 1 year interval. Bioptic specimens (length range: 1–4.2 cm, at least 4 portal spaces) were evaluated according to the METAVIR score. The cut-off value to use for the identification of significant fibrosis (F ≥ 2) was obtained by the ROC curve analysis. Results: The METAVIR fibrosis stages were: F0 = 7, F1 = 9, F2 = 6, F3 = 1, F4 = 1; the average stiffness was calculated for all the histological fibrosis stages (F0 = 4.72±1.12 kPa, F1 = 4.4±0.64 kPa, F2 = 5.7±2.31 kPa, F3 = 6.8 kPa, F4 = 10.1 kPa). There was a statistically significant correlation between TE and METAVIR (R = 0.571, p = 0.004). The diagnostic accuracy of TE for the diagnosis of fibrosis (F ≥ 2), which was calculated by a comparison between the liver stiffness and METAVIR as gold standard, measured as an area under the curve (AUROC), gave a result equal to 0.715, showing that the method had a good diagnostic performance. A stiffness cut-off of 6.6 kPa was identified as the best value associated with significant fibrosis (F ≥ 2) (sensitivity 62.5%, specificity 100%, PPV 100% and NPV 84.21%). Conclusions: TE is a simple, non-invasive, reliable tool to assess and monitor the progression of liver fibrosis in paediatric transplanted liver patients. If liver stiffness is <6.6 kPa a significant fibrosis can be excluded. Therefore, these results suggest that follow-up liver fibrosis biopsy could be reserved to selected cases with a liver stiffness of ≥6.6 kPa. Further studies are ongoing on larger cohorts. 527 SOLID ORGAN CANCER INCIDENCE AFTER LIVER TRANSPLANTATION (LT) IS 4-FOLD HIGHER THAN IN GENERAL POPULATION C. Carenco1 , Y. Duny2 , E. Assenat1 , S. Faure1 , A. Herrero1 , M. Bismuth1 , F. Navarro1 , S. Jaber1 , D. Larrey1 , G.P. Pageaux1 . 1 Liver Unit of Transplantation, Hˆ opital Saint Eloi, 2 Biostatistics, IERC, Hˆ opital Lapeyronie, Montpellier, France E-mail: [email protected] Introduction: Long-term follow-up of LT recipients is characterized by the emergence of de novo malignancies with a poor prognosis. This additional risk of cancer amongst LT recipients, has been insufficiently evaluated. Aim: To evaluate the incidence of de novo malignancies amongst LT recipients compared to the general population. Methods: All LT recipients between 1991–2010, who survived at least 6 months, were included. Each new case of cancer was prospectively noted. Overall incidence and standardized incidence on age were calculated and compared to a regional cancer register. Results: 460 patients, 74.6% of male, mean age 49.9 years, were included. Main indications for LT were alcohol (47.5%), HCV (22.2%) S216
and HCC (13.5%). Before LT, 291 patients had an excessive alcohol consumption (67.8%) and 235 had an history of smoking (60.4%). After LT, 56 patients had an excessive alcohol consumption (12.6%) and 149 patients were still smokers (35.6%). The mean follow-up was 63.3 months. 94 cancers were diagnosed during follow-up: 52 solid tumour (55.3%), 31 skin cancer (33%), 11 PTLD (11.7%). The break-down of solid cancers was: upper airways malignancies 27%, digestive tumour 25%, lung cancer 23% and others 25%. The other cancers were: breast, prostate, bladder, testicle, unknown primitive, and sarcoma. Mean delay for diagnosis of solid cancer was 65.5 months. Patients who developed a solid cancer had a significantly reduced 10-year survival (51.3% vs 82.5% in patients without solid cancer or skin cancer; p < 0.0001). Solid cancer overall incidence was 1311 cases/100 000 persons/year in LT recipients, compared to 321 in the regional registrer. Standardization on age incidences were 760 and 194 respectively. Alcohol consumption before and after LT was significantly higher in patients developing a solid cancer (before LT: OR = 2.8, 95% CI [1.3–6.1], p = 0.008; after LT: OR = 2.5, 95% CI [1.2–5.1], p = 0.02). The same difference applied for tobacco consumption (before LT: OR = 4, 95% CI [1.7–9.2], p = 0.0005; after LT: OR = 3, 95% CI [1.6–5.5], p = 0.00004). This was noted for upper airways and lung cancers, but not in other localisations. Conclusion: The additional risk of developing a solid cancer in LT recipients appears to be relevant and linked to alcohol and tobacco consumption. 528 IMPROVEMENT OF SURVIVAL IN 24 MONTHS OF PATIENTS IN LIVER TRANSPLANT LIST AFTER THE INTRODUCTION OF MELD IN BRAZIL 1 R.S. Castro1 , T. Seva-Pereira ´ , D.B. Dei Santi2 , H. Machado3 , 1 4 J.R.S. Almeida , I.F.S.F. Boin , E.C. Soares1 , Grupo de Estudo do F´ıgado. 1 Gastroenterology, 2 Unicamp, 3 Statistic – Medical Science Faculty, 4 Surgery, Unicamp, Campinas, Brazil E-mail: [email protected] Objectives: 1. Assess, after 2 years, if the official introduction of model for EndStage Liver Disease (MELD), as a criterion for allocation of organs, improved the survival of patients in list of liver transplantation. 2. Study factors related to death of the patients. Methods: Patients were analyzed on the waiting list for liver transplantation in Clinic Hospital (Unicamp), Campinas, 2 years after the implantation of MELD in Brazil. Patients were divided into three groups, for better comparison between the results: Group 1 – patients belonging to the waiting list of liver transplantion 2 years before the introduction of MELD in Brazil, Group 2 – patients on the waiting list of liver transplantion 2 years after the introduction of MELD and Group 3 – patients on the waiting list since the period before the introduction of MELD who survived and have remained in list after the introduction of MELD. The study of survival of patients in each group was performed through long-rank test and demonstrated in Kaplan Meyer curve. Predictive factors identified survival in the univariate analysis were included in the multivariate analysis using the Cox regression method. Results: We studied 159 patients in Group 1, 77 patients in Group 2 and 227 patients in Group 3. Group 3 was excluded of analysis. Survival rates of patients were analyzed in 3, 6, 9, 12 and 24 months in two groups. In Group 1 survival in 3, 6, 9, 12 and 24 months was respectively 91.1%, 81.6%, 76.4%, 73.8% and 56.4%, in Group 2 was 89.8%, 80.3%, 77.6%,73.9% and 65.7%. Statistically significant difference between the two groups was observed (P < 0.001) with greater survival for group 2 in relation to group 1 to the end of 24 months. The multivariate analysis showed in group 2, that
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POSTERS independent factors related to death were hepatic encephalopathy and gastrointestinal bleeding. Conclusion: The survival of patients in the list awaiting liver transplantation improved after 2 years of the introduction of the criterion of severity using the MELD, in our service. 529 PROTEINURIA PREDICTS UNFAVOURABLE EVOLUTION AFTER SWITCHING OF IMMUNOSUPRESSION FROM CALCINEURIN-INHIBITOR TO EVEROLIMUS IN LIVER TRANSPLANT RECIPIENTS WITH CHRONIC RENAL DYSFUNCTION J. Castroagudin1 , E. Molina1 , E. Varo2 . 1 Liver Unit, 2 Liver Transplantation Unit, Hospital Cl´ınico Universitario de Santiago, Santiago de Compostela, Spain E-mail: [email protected] Background: Chronic renal dysfunction (CRD) is a frequent and severe complication in solid-organ transplant recipients. The immunosuppressive agents calcineurin inhibitors (CNI) are the main pathogenic factors of renal dysfunction. Switching from CNI to non-nephrotoxic drugs such as everolimus may improve renal function in these patients, but their efficacy and predictive factors of response have not been evaluated. Aim: To analyse the efficacy of an immunosuppressive protocol based on everolimus and withdrawal of CNI in liver transplant recipients with CRD. Methods: 30 liver transplant recipients (26 male, mean age 60.1±8.9 years) with CRD (creatinine >1.4 mg/dL) were prospectively included. Basal creatinine values were 1.67±0.23 mg/dL. Glomerular filtration rate (GFR) evaluated by means of MDRD-4 formula was 42.59±8.35 mL/min/m2 . Everolimus (Certican® , Novartis) was initiated at dosage of 0.75 mg bid, with target levels of 3–8 ng/mL. Withdrawal of CNI was made after target levels of everolimus were reached. Periodical controls of weight, arterial pressure, liver function tests, serum creatinine, levels of everolimus, proteinuria, creatinine clearance (Cockroft-Gault), and GFR at 1, 6, 12, 18, and 24 months. Results: After a median follow-up of 860 days, 11 recipients (36.7%) presented proteinuria >0.5 g/day. In the global series, creatinine values at 1, 6, 12, 18, and 24 months did not significantly differ from basal values. Nevertheless, in patients which did not develop significant proteinuria, respective creatinine values at 1, 6, 12, 18, and 24 months were 1.59±0.32 (p = 0.036 respect to basal), 1.59±0.27 (p = 0.198), 1.50±0.26 (p = 0.008), 1.55±0.32 (p = 0.008) and 1.52±0.22 mg/dL (p = 0.010). Basal creatinine <1.8 mg/dL, pre-conversion peak creatinine <2 mg/dL, and basal GFR >45 mL/min/m2 were associated with normalisation of renal function (creatinine <1.3 mg/dL). In 26 recipients (86.3%) CNI was completely withdrawn. Rejection was not detected in any case. Conclusions: In the present series, an immunosuppressive protocol based on switching from CNI to everolimus in liver transplant recipients with CRD was associated with improvement of renal function in recipients with less deterioration of renal function at baseline and in which significant proteinuria (>0.5 g/day) was not developed. Proteinuria could be a marker of failure and unfavourable evolution after conversion.
530 ANATOMICAL VARIATIONS OF HEPATIC VEINS: A 3-DIMENSIONAL COMPUTERIZED TOMOGRAPHY SCAN ON 200 SUBJECTS F. Chi-Hua1 , Y. Jin-Hua1 , L. Wan Yee2 , L. Eric C.h.2 , F. Ying-Fang1 , Z. Shi-Zhen3 , L. Ke-Xiao1 , C. Zhi-Xiang1 , S. Zhong-He1 , B. Su-Su4 . 1 Department of Hepatobiliary Surgery, Zhujiang Hospital, The Southern Medical University, Guangzhou, 2 Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, 3 The Clinical Anatomy Institute, Southern Medical University, 4 The Computer School, South China Normal University, Guangzhou, China E-mail: [email protected] Background: The impact of hepatic venous anatomical variations on hepatic resection and transplantation is the least understood aspect of liver surgery. Methods: A prospective Three-dimensional computerized tomography scan study was undertaken on 200 consecutive subjects with normal livers to determine the prevalence of surgically significant hepatic venous anatomical variations. Results: The prevailing pattern of the 3 hepatic veins was a right hepatic vein (RHV), and a common trunk of the middle (MHV) and left hepatic veins (LHV) (122/200 = 61%). The remaining patients had the right, middle, and left hepatic veins draining independently into the inferior vena cava (IVC). In 39% of patients, the RHV was small and was compensated by a large right inferior hepatic vein (21%), an accessory RHV (8.5%) or a well-developed MHV (6.5%). A segment 4 vein was seen in 51.5% of patients. This segment 4 vein joined the LHV (26%), the MHV (17.5%) or the IVC (8%). An umbilical vein and a segment 4 vein were seen in (3.5%) of patients. Both these 2 veins either joined the LHV (2%) or the MHV (1.5%). Conclusions: Knowing the variations of hepatic veins before surgery is useful in partial hepatectomy and in donor operations for living related liver transplantation. 531 EARLY IDENTIFICATION OF TWO PATTERNS OF HEPATITIS C RECURRENCE (RAPID AND SLOW PROGRESSORS) AFTER LIVER TRANSPLANTATION: A PROSPECTIVE LONG-TERM FOLLOW-UP STUDY G. Crespo1 , J.A. Carrion ´ 1 , S. Lens1 , M. Garc´ıa-Retortillo1 , R. Miquel2 , J.C. Garc´ıa-Pagan ´ 1 , C. Fondevila3 , J.C. Garc´ıa-Valdecasas3 , J. Bosch1 , M. Bruguera1 , M. Navasa1 , X. Forns1 . 1 Liver Unit, Institut de Malalties Digestives, IDIBAPS, Ciberehd, 2 Pathology Department, Institut de Malalties Digestives, IDIBAPS, Ciberehd, 3 Liver Surgery Department, Institut de Malalties Digestives, IDIBAPS, Ciberehd, Hospital Clinic, Barcelona, Spain E-mail: [email protected] Background and Aims: Hepatitis C recurrence after liver transplantation (LT) is a main cause of graft loss and patient mortality. The aim of our study was to analyze the natural history of hepatitis C recurrence and to identify variables predicting poor outcomes. Methods: Between 2000 and 2009 333 HCV-infected liver transplant recipients were prospectively followed in a single center. The primary endpoints of the study were clinical decompensation and graft loss (death or retransplantation). Results: Median follow-up was 49 months (range 3–139). Cumulative probabilities of clinical decompensation at 3, 5 and 10 years were 23%, 28% and 34%, respectively. The figures for graft loss were 23%, 31% and 42%, respectively. The presence of significant fibrosis (≥F2) and/or hepatic venous pressure gradient (HVPG) ≥6 mmHg one year after LT (severe recurrence) was the best predictor of clinical decompensation and graft loss. This variable identified two distinct patterns of disease progression: in patients with severe recurrence, the probabilities of decompensation at 3, 5 and 10 years were 53%, 58% and 61%, respectively, whereas in patients with mild recurrence the figures were 1%, 6% and 15% (log
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and HCC (13.5%). Before LT, 291 patients had an excessive alcohol consumption (67.8%) and 235 had an history of smoking (60.4%). After LT, 56 patients had an excessive alcohol consumption (12.6%) and 149 patients were still smokers (35.6%). The mean follow-up was 63.3 months. 94 cancers were diagnosed during follow-up: 52 solid tumour (55.3%), 31 skin cancer (33%), 11 PTLD (11.7%). The break-down of solid cancers was: upper airways malignancies 27%, digestive tumour 25%, lung cancer 23% and others 25%. The other cancers were: breast, prostate, bladder, testicle, unknown primitive, and sarcoma. Mean delay for diagnosis of solid cancer was 65.5 months. Patients who developed a solid cancer had a significantly reduced 10-year survival (51.3% vs 82.5% in patients without solid cancer or skin cancer; p < 0.0001). Solid cancer overall incidence was 1311 cases/100 000 persons/year in LT recipients, compared to 321 in the regional registrer. Standardization on age incidences were 760 and 194 respectively. Alcohol consumption before and after LT was significantly higher in patients developing a solid cancer (before LT: OR = 2.8, 95% CI [1.3–6.1], p = 0.008; after LT: OR = 2.5, 95% CI [1.2–5.1], p = 0.02). The same difference applied for tobacco consumption (before LT: OR = 4, 95% CI [1.7–9.2], p = 0.0005; after LT: OR = 3, 95% CI [1.6–5.5], p = 0.00004). This was noted for upper airways and lung cancers, but not in other localisations. Conclusion: The additional risk of developing a solid cancer in LT recipients appears to be relevant and linked to alcohol and tobacco consumption. 528 IMPROVEMENT OF SURVIVAL IN 24 MONTHS OF PATIENTS IN LIVER TRANSPLANT LIST AFTER THE INTRODUCTION OF MELD IN BRAZIL 1 R.S. Castro1 , T. Seva-Pereira ´ , D.B. Dei Santi2 , H. Machado3 , 1 4 J.R.S. Almeida , I.F.S.F. Boin , E.C. Soares1 , Grupo de Estudo do F´ıgado. 1 Gastroenterology, 2 Unicamp, 3 Statistic – Medical Science Faculty, 4 Surgery, Unicamp, Campinas, Brazil E-mail: [email protected] Objectives: 1. Assess, after 2 years, if the official introduction of model for EndStage Liver Disease (MELD), as a criterion for allocation of organs, improved the survival of patients in list of liver transplantation. 2. Study factors related to death of the patients. Methods: Patients were analyzed on the waiting list for liver transplantation in Clinic Hospital (Unicamp), Campinas, 2 years after the implantation of MELD in Brazil. Patients were divided into three groups, for better comparison between the results: Group 1 – patients belonging to the waiting list of liver transplantion 2 years before the introduction of MELD in Brazil, Group 2 – patients on the waiting list of liver transplantion 2 years after the introduction of MELD and Group 3 – patients on the waiting list since the period before the introduction of MELD who survived and have remained in list after the introduction of MELD. The study of survival of patients in each group was performed through long-rank test and demonstrated in Kaplan Meyer curve. Predictive factors identified survival in the univariate analysis were included in the multivariate analysis using the Cox regression method. Results: We studied 159 patients in Group 1, 77 patients in Group 2 and 227 patients in Group 3. Group 3 was excluded of analysis. Survival rates of patients were analyzed in 3, 6, 9, 12 and 24 months in two groups. In Group 1 survival in 3, 6, 9, 12 and 24 months was respectively 91.1%, 81.6%, 76.4%, 73.8% and 56.4%, in Group 2 was 89.8%, 80.3%, 77.6%,73.9% and 65.7%. Statistically significant difference between the two groups was observed (P < 0.001) with greater survival for group 2 in relation to group 1 to the end of 24 months. The multivariate analysis showed in group 2, that
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POSTERS independent factors related to death were hepatic encephalopathy and gastrointestinal bleeding. Conclusion: The survival of patients in the list awaiting liver transplantation improved after 2 years of the introduction of the criterion of severity using the MELD, in our service. 529 PROTEINURIA PREDICTS UNFAVOURABLE EVOLUTION AFTER SWITCHING OF IMMUNOSUPRESSION FROM CALCINEURIN-INHIBITOR TO EVEROLIMUS IN LIVER TRANSPLANT RECIPIENTS WITH CHRONIC RENAL DYSFUNCTION J. Castroagudin1 , E. Molina1 , E. Varo2 . 1 Liver Unit, 2 Liver Transplantation Unit, Hospital Cl´ınico Universitario de Santiago, Santiago de Compostela, Spain E-mail: [email protected] Background: Chronic renal dysfunction (CRD) is a frequent and severe complication in solid-organ transplant recipients. The immunosuppressive agents calcineurin inhibitors (CNI) are the main pathogenic factors of renal dysfunction. Switching from CNI to non-nephrotoxic drugs such as everolimus may improve renal function in these patients, but their efficacy and predictive factors of response have not been evaluated. Aim: To analyse the efficacy of an immunosuppressive protocol based on everolimus and withdrawal of CNI in liver transplant recipients with CRD. Methods: 30 liver transplant recipients (26 male, mean age 60.1±8.9 years) with CRD (creatinine >1.4 mg/dL) were prospectively included. Basal creatinine values were 1.67±0.23 mg/dL. Glomerular filtration rate (GFR) evaluated by means of MDRD-4 formula was 42.59±8.35 mL/min/m2 . Everolimus (Certican® , Novartis) was initiated at dosage of 0.75 mg bid, with target levels of 3–8 ng/mL. Withdrawal of CNI was made after target levels of everolimus were reached. Periodical controls of weight, arterial pressure, liver function tests, serum creatinine, levels of everolimus, proteinuria, creatinine clearance (Cockroft-Gault), and GFR at 1, 6, 12, 18, and 24 months. Results: After a median follow-up of 860 days, 11 recipients (36.7%) presented proteinuria >0.5 g/day. In the global series, creatinine values at 1, 6, 12, 18, and 24 months did not significantly differ from basal values. Nevertheless, in patients which did not develop significant proteinuria, respective creatinine values at 1, 6, 12, 18, and 24 months were 1.59±0.32 (p = 0.036 respect to basal), 1.59±0.27 (p = 0.198), 1.50±0.26 (p = 0.008), 1.55±0.32 (p = 0.008) and 1.52±0.22 mg/dL (p = 0.010). Basal creatinine <1.8 mg/dL, pre-conversion peak creatinine <2 mg/dL, and basal GFR >45 mL/min/m2 were associated with normalisation of renal function (creatinine <1.3 mg/dL). In 26 recipients (86.3%) CNI was completely withdrawn. Rejection was not detected in any case. Conclusions: In the present series, an immunosuppressive protocol based on switching from CNI to everolimus in liver transplant recipients with CRD was associated with improvement of renal function in recipients with less deterioration of renal function at baseline and in which significant proteinuria (>0.5 g/day) was not developed. Proteinuria could be a marker of failure and unfavourable evolution after conversion.
530 ANATOMICAL VARIATIONS OF HEPATIC VEINS: A 3-DIMENSIONAL COMPUTERIZED TOMOGRAPHY SCAN ON 200 SUBJECTS F. Chi-Hua1 , Y. Jin-Hua1 , L. Wan Yee2 , L. Eric C.h.2 , F. Ying-Fang1 , Z. Shi-Zhen3 , L. Ke-Xiao1 , C. Zhi-Xiang1 , S. Zhong-He1 , B. Su-Su4 . 1 Department of Hepatobiliary Surgery, Zhujiang Hospital, The Southern Medical University, Guangzhou, 2 Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, 3 The Clinical Anatomy Institute, Southern Medical University, 4 The Computer School, South China Normal University, Guangzhou, China E-mail: [email protected] Background: The impact of hepatic venous anatomical variations on hepatic resection and transplantation is the least understood aspect of liver surgery. Methods: A prospective Three-dimensional computerized tomography scan study was undertaken on 200 consecutive subjects with normal livers to determine the prevalence of surgically significant hepatic venous anatomical variations. Results: The prevailing pattern of the 3 hepatic veins was a right hepatic vein (RHV), and a common trunk of the middle (MHV) and left hepatic veins (LHV) (122/200 = 61%). The remaining patients had the right, middle, and left hepatic veins draining independently into the inferior vena cava (IVC). In 39% of patients, the RHV was small and was compensated by a large right inferior hepatic vein (21%), an accessory RHV (8.5%) or a well-developed MHV (6.5%). A segment 4 vein was seen in 51.5% of patients. This segment 4 vein joined the LHV (26%), the MHV (17.5%) or the IVC (8%). An umbilical vein and a segment 4 vein were seen in (3.5%) of patients. Both these 2 veins either joined the LHV (2%) or the MHV (1.5%). Conclusions: Knowing the variations of hepatic veins before surgery is useful in partial hepatectomy and in donor operations for living related liver transplantation. 531 EARLY IDENTIFICATION OF TWO PATTERNS OF HEPATITIS C RECURRENCE (RAPID AND SLOW PROGRESSORS) AFTER LIVER TRANSPLANTATION: A PROSPECTIVE LONG-TERM FOLLOW-UP STUDY G. Crespo1 , J.A. Carrion ´ 1 , S. Lens1 , M. Garc´ıa-Retortillo1 , R. Miquel2 , J.C. Garc´ıa-Pagan ´ 1 , C. Fondevila3 , J.C. Garc´ıa-Valdecasas3 , J. Bosch1 , M. Bruguera1 , M. Navasa1 , X. Forns1 . 1 Liver Unit, Institut de Malalties Digestives, IDIBAPS, Ciberehd, 2 Pathology Department, Institut de Malalties Digestives, IDIBAPS, Ciberehd, 3 Liver Surgery Department, Institut de Malalties Digestives, IDIBAPS, Ciberehd, Hospital Clinic, Barcelona, Spain E-mail: [email protected] Background and Aims: Hepatitis C recurrence after liver transplantation (LT) is a main cause of graft loss and patient mortality. The aim of our study was to analyze the natural history of hepatitis C recurrence and to identify variables predicting poor outcomes. Methods: Between 2000 and 2009 333 HCV-infected liver transplant recipients were prospectively followed in a single center. The primary endpoints of the study were clinical decompensation and graft loss (death or retransplantation). Results: Median follow-up was 49 months (range 3–139). Cumulative probabilities of clinical decompensation at 3, 5 and 10 years were 23%, 28% and 34%, respectively. The figures for graft loss were 23%, 31% and 42%, respectively. The presence of significant fibrosis (≥F2) and/or hepatic venous pressure gradient (HVPG) ≥6 mmHg one year after LT (severe recurrence) was the best predictor of clinical decompensation and graft loss. This variable identified two distinct patterns of disease progression: in patients with severe recurrence, the probabilities of decompensation at 3, 5 and 10 years were 53%, 58% and 61%, respectively, whereas in patients with mild recurrence the figures were 1%, 6% and 15% (log
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