Results of a retrospective analysis showed histologic changes associated with active hepatitis C in patients who had achieved sustained virologic response following liver transplantation for chronic HCV.
“The number of post-transplant patients achieving SVR has been historically so low, the availability of such biopsies for study has been limited,” Emma Whitcomb, MD, from the University of Calgary, Alberta, and colleagues wrote. “As the number of patients achieving SVR post liver-transplant grows in the [direct-acting antiviral (DAA)] era, allograft liver biopsies sent for pathologic evaluation are more likely to be status-post SVR. It is therefore increasingly important to recognize the features that can be expected in this setting, especially since pathologists may not be aware of the treatment status of a patient.”
Study data included 170 biopsies taken between 1999 and 2015 from 36 patients who underwent liver transplantation for chronic HCV. There were 65 available post-SVR biopsies, 36 of which were initial readings and 29 were additional readings. SVR in this cohort was defined as undetectable serum HCV RNA at 24 weeks.
Regarding the 65 post-SVR biopsies, 45 presented recurrent HCV, according to the researchers. Of the 36 initial post-SVR biopsies, 32 had histologic features of HCV necroinflammatory activity. The researchers reviewed the duration of SVR over five time periods (0-6 months, 7-12 months, 1-3 years, 3-5 years and more than 5 years) and found that HCV-type activity was seen in 57% to 93% of the biopsies throughout the time periods.
The researchers compared results of pre- and post-SVR biopsies. There was a marked reduction of activity grade in 52% and reduction of fibrosis progression in 24%. Activity grade worsened in 14% of patients and fibrosis progression worsened in 31%. There was no change for activity grade in 34% and fibrosis progression in 45%. In patients with more than one post-SVR biopsy, the researchers found 6 patients who had the same level of fibrosis and 3 who had progressed to a worsened stage.
“While the exact reasons remain unknown, the results of this study show that following SVR, the features of HCV hepatitis including both necroinflammatory activity and fibrosis progression frequently persists in allograft livers. To avoid an incorrect diagnosis of recurrent/persistent HCV ... awareness of the SVR status is necessary,” the researchers wrote. “Until the long-term histologic changes of cured HCV in allograft liver are more unequivocally established, it would be prudent for clinicians to follow these patients closer than their HCV cleared status would otherwise suggest.” – by Talitha Bennett
Whitcomb reports no report relevant financial disclosures. Please see the full study for the other researchers’ relevant financial disclosures.