Hepatic venous pressure gradient identifies patients at risk of severe hepatitis C recurrence after liver transplantation

TLDR

Liver biopsy is essential for monitoring HCV‑infected liver transplant recipients. The study prospectively compared percutaneous and transjugular liver biopsies for assessing liver damage and evaluated whether hepatic venous pressure gradient (HVPG) could identify patients at risk of severe HCV recurrence after transplantation. A total of 116 paired percutaneous and transjugular biopsies, each with HVPG measurement, were performed at 3 or 12 months post‑transplant in 80 patients. Concordance between PLB and TLB for necroinflammation and fibrosis was fair to good (kappa ≥ 0.6), and at one year post‑transplant HVPG correlated strongly with fibrosis stage and, with an AUC of 0.96, HVPG ≥ 6 mm Hg proved highly accurate for predicting clinical decompensation, outperforming fibrosis stage alone (AUC 0.80).

Abstract

Liver biopsy is essential in the follow-up of HCV-infected liver transplant recipients. The aim of this study was to prospectively compare percutaneous (PLB) versus transjugular liver biopsy (TLB) in the assessment of liver damage. We also explored the diagnostic value of hepatic venous pressure gradient (HVPG) to identify patients at risk of severe HCV disease recurrence after liver transplantation (LT). One hundred sixteen paired PLB and TLB (with HVPG measurement) were performed 3 or 12 months after LT in 80 patients. Concordance for necroinflammation and fibrosis was fair or good, particularly 1 year after LT (kappa > or = 0.6). At this point, a significant positive association was seen between the median HVPG and the fibrosis stage (2.5 mm Hg for F0; 5 mm Hg for F1, 6 mm Hg for F2, and 11.5 mm Hg for F3; Kruscal-Wallis < 0.001). Despite this strong association, portal hypertension (HVPG > or = 6 mm Hg) was detected in 1 (5%) of 22, 4 (16%) of 25, and 6 (60%) of 10 patients with fibrosis stages 0, 1, and 2, respectively. After a median follow-up of 38 months, clinical decompensation occurred in 15 (19%) of 80 patients. Although the presence of significant fibrosis (F2-F3) 1 year after transplantation was good to predict clinical decompensation (AUC: 0.80), an HVPG of 6 mm Hg or greater was extremely accurate at identifying patients at risk of disease progression (AUC: 0.96). In conclusion, HVPG determination is a valuable tool for follow-up in patients with HCV recurrence after LT.