Elsevier

Transplantation Proceedings

Volume 42, Issue 10, December 2010, Pages 4573-4577
Transplantation Proceedings

Liver transplantation
Outcome
Results of a Two-Center Study Comparing Hepatic Fibrosis Progression in HCV-positive Liver Transplant Patients Receiving Cyclosporine or Tacrolimus

https://doi.org/10.1016/j.transproceed.2010.10.013Get rights and content

Abstract

A 2-center retrospective analysis was performed in 60 patients undergoing liver transplantation for hepatitis C virus (HCV)–related disease (cyclosporine in 20, tacrolimus in 40). Mean (±SEM) follow-up was 23.6 ± 22.5 and 22.3 ± 13.7 months in patients receiving cyclosporine or tacrolimus, respectively. Clinically indicated biopsies were performed in 15/20 cyclosporine patients (75%) and 22/40 tacrolimus patients (55%; P = .17). The Ishak fibrosis score was significantly lower in cyclosporine-treated patients versus tacrolimus-treated patients (mean 1.7 ± 0.4 vs 3.1 ± 0.4; P = .023), as was percentage of fibrosis grade Ishak ≥4 (7% vs 41%; P = .028). The mean time to moderate fibrosis (Ishak score ≥3) was 38.2 ± 15.1 months in cyclosporine patients (4/15) and 23.5 ± 12.6 months in tacrolimus patients (14/22); the difference was not statistically significant (P = .09). This retrospective study suggests that cyclosporine-based immunosuppression is associated with less severe hepatic fibrosis in HCV-positive liver transplant recipients compared with tacrolimus-based regimens, but a larger prospective comparative trial is necessary to confirm these findings.

Section snippets

Methods

In this retrospective study, data were examined from a sequential series of patients undergoing liver transplantation for HCV-related liver disease at 2 centers. All patients receiving a primary liver transplant during the period 1993–2005 who had a follow-up of ≥1 year were eligible for inclusion. Maintenance immunosuppression at both centers comprised either CsA or tacrolimus and corticosteroids, with or without azathioprine. Liver biopsy was performed on clinical indication in response to

Results

In total, 60 patients underwent transplantation for HCV-related disease during the period 1993–2005, of whom 38 were transplanted at Rotterdam and 22 in Newcastle. Of these, 20 (33.3%) received CsA and 40 (66.6%) received tacrolimus. Mean follow-up was 23.6 ± 22.5 months (range, 3–82 months) in the CsA-treated group and 22.3 ± 13.7 months in the tacrolimus-treated group (range, 3–55 months). All patients received low-dose corticosteroids during the first 6 months after transplantation. The

Discussion

Results from this retrospective 2-center analysis indicate that despite similar recipient and donor characteristics, HCV-positive liver transplantation patients given a CsA-based regimen experience less severe hepatic fibrosis progression then those given tacrolimus, and that development of fibrosis is delayed. Of note, cirrhosis developed only in patients receiving tacrolimus. The increased fibrosis seen in tacrolimus-treated patients appeared independent of PTDM and was also observed in

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