Severe fibrosis in patients with recurrent hepatitis C after liver transplantation: a French experience on 250 patients over 15 years (the Orfèvre study).

Summary Background and aims Recurrent hepatitis C after liver transplantation (LT) is associated with rapid fibrosis progression. The aim of this study was to evaluate the cumulative risk for severe fibrosis and the factors influencing it. Patients and methods Two hundred and fifty LT patients were included 1 to 15 years after LT. Recurrence of chronic hepatitis C on liver graft was classified according to Metavir score. Results Kaplan-Meyer estimates for actuarial progression to severe fibrosis (Metavir > F3) showed a probability of 15.2% and 44.5% at 5 and 10 years, respectively. Predictive factors for progression to severe fibrosis were: use of tacrolimus as main CNI, recipient age at time of biopsy  P  = 0.0058) and lack of response to antiviral treatment (hazard ratio 2.816, 95%CI 1.227–6.464, P  = 0.0146) were associated to severe fibrosis. Conclusions Our study confirms that donor age ≥ 45 and lack of response to antiviral treatment after LT are major predictive factors of progression of HCV recurrence on liver graft.