Changes in graft density after effective treatment of recurrent hepatitis C in liver transplant recipients during long-term follow-up

Background. The main mechanism underlying the progression of chronic liver transplant disease is an increase in fibrosis, which is associated with an increase in liver density. An effective antiviral therapy for recurrent hepatitis C has led to the increased graft and recipient survival rates.

Objective. To study the long-term effect of successful antiviral therapy on changes in the graft fibrosis stage in liver transplant recipients with recurrent hepatitis C.

Material and methods. Transient elastography was used to study the change in liver density in 33 liver transplant recipients with recurrent hepatitis C before the start of antiviral therapy and 54 months (IQR: 37;59) after its completion. The median liver densities before antiviral therapy and at the end of follow–up were 7.8 kPa (IQR: 6.1;12.0), and 6.4 kPa, respectively (IQR: 5.5;7.7; p<0.0001). Upon completion of the follow–up, the fibrosis stage decreased by 2 in 4 (12.1%) recipients, by 1 in 8 (24.2%) recipients. In 19 (57.6%) cases, the stage of fibrosis did not change, and in 2 (6.1%) recipients it increased by 1. No clear correlations were found between any of the following parameters: alanine aminotransferase activity, gamma-glutamyltranspeptidase activity, body mass index and the liver density assessed before the start of antiviral therapy and on follow-up completion.

Conclusion. Effective antiviral therapy leads to a long-term (over 4-5 years) decrease in liver density, which is largely due to the slowdown and reverse progression of liver fibrosis. The effect of non-HCV-related risk factors on liver density in this patient population is not significant.

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