The Royal Free Sheila Sherlock Liver Centre and Division of Surgery and Interventional Sciences, University College London, London, UK.
Liver Transpl. 2011 Feb;17(2):178-88. doi: 10.1002/lt.22209.
Clinical outcomes of recurrent hepatitis C virus after liver transplantation are difficult to predict. We evaluated collagen proportionate area (CPA), a quantitative histological index, at 1 year with respect to the first episode of clinical decompensation. Patients with biopsies at 1 year after liver transplantation were evaluated by Ishak stage/grade, and biopsy samples stained with Sirius red for digital image analysis were evaluated for CPA. Cox regression was used to evaluate variables associated with first appearance of clinical decompensation. Receiver operating characteristic (ROC) curves were also used. A total of 135 patients with median follow-up of 76 months were evaluated. At 1 year, median CPA was 4.6% (0.2%-36%) and Ishak stage was 0-2 in 101 patients, 3-4 in 23 patients, and 5-6 in 11 patients. Decompensation occurred in 26 (19.3%) at a median of 61 months (15-138). Univariately, CPA, tacrolimus monotherapy, and Ishak stage/grade at 1 year were associated with decompensation; upon multivariate analysis, only CPA was associated with decompensation (P = 0.010; Exp(B) = 1.169; 95%CI, 1.037-1.317). Area under the ROC curve was 0.97 (95%CI, 0.94-0.99). A cutoff value of 6% of CPA had 82% sensitivity and 95% specificity for decompensation. In the 89 patients with hepatic venous pressure gradient (HVPG) measurement, similar results were obtained. When both cutoffs of CPA > 6% and HVPG ≥ 6 mm Hg were used, all patients decompensated. Thus, CPA at 1-year biopsy after liver transplantation was highly predictive of clinical outcome in patients infected with hepatitis C virus who underwent transplantation, better than Ishak stage or HVPG.
移植后复发性丙型肝炎病毒的临床结果难以预测。我们评估了 1 年内胶原比例区（CPA），这是一个定量组织学指标，与首次临床失代偿有关。对肝移植后 1 年内进行活检的患者进行了 Ishak 分期/分级评估，并对天狼星红染色的活检样本进行了数字图像分析以评估 CPA。使用 Cox 回归评估与首次出现临床失代偿相关的变量。还使用了受试者工作特征（ROC）曲线。共评估了 135 例中位随访 76 个月的患者。在 1 年内，中位数 CPA 为 4.6%（0.2%-36%），101 例患者的 Ishak 分期为 0-2 期，23 例患者为 3-4 期，11 例患者为 5-6 期。中位时间为 61 个月（15-138 个月）时，26 例患者（19.3%）出现失代偿。单变量分析显示，CPA、他克莫司单药治疗和 1 年内的 Ishak 分期/分级与失代偿有关；多变量分析显示，只有 CPA 与失代偿有关（P=0.010；Exp（B）=1.169；95%CI，1.037-1.317）。ROC 曲线下面积为 0.97（95%CI，0.94-0.99）。CPA 为 6%的截断值对失代偿的敏感性为 82%，特异性为 95%。在 89 例有肝静脉压力梯度（HVPG）测量的患者中，得到了类似的结果。当同时使用 CPA>6%和 HVPG≥6mmHg 的两个截定点时，所有患者均出现失代偿。因此，肝移植后 1 年内的活检 CPA 对丙型肝炎病毒感染患者的移植后临床结果具有高度预测性，优于 Ishak 分期或 HVPG。
