Viral Hepatitis
Copyright ©The Author(s) 2005. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 14, 2005; 11(38): 5944-5950
Published online Oct 14, 2005. doi: 10.3748/wjg.v11.i38.5944
Excess body weight, liver steatosis, and early fibrosis progression due to hepatitis C recurrence after liver transplantation
Pierluigi Toniutto, Carlo Fabris, Claudio Avellini, Rosalba Minisini, Davide Bitetto, Elisabetta Rossi, Carlo Smirne, Mario Pirisi
Pierluigi Toniutto, Carlo Fabris, Davide Bitetto, Elisabetta Rossi, Liver Transplantation Unit, Department of Pathology and Medicine Experimental and Clinical (DPMSC), University of Udine, Udine, Italy
Claudio Avellini, Pathology, University of Udine, Udine, Italy
Rosalba Minisini, Carlo Smirne, Mario Pirisi, Department of Medical Sciences, University of Eastern Piedmont "A. Avogadro", Novara, Italy
Author contributions: All authors contributed equally to the work.
Correspondence to: Dr. Pierluigi Toniutto, Clinica di Medicina Interna, Università degli Studi, Piazzale Santa Maria della Misericordia, 1, Udine 33100, Italy. pierluigi.toniutto@uniud.it
Telephone: +39-432-559824 Fax: +39-432-42097
Received: December 22, 2004
Revised: April 15, 2005
Accepted: April 18, 2005
Published online: October 14, 2005
Abstract

AIM: To investigate how weight gain after OLT affects the speed of fibrosis progression (SFP) during recurrent hepatitis C virus (HCV) infection of the graft.

METHODS: Ninety consecutive patients (63 males, median age 53 years; 55 with HCV-related liver disease), transplanted at a single institution, were studied. All were followed for at least 2 years after OLT and had at least one follow-up graft biopsy, performed not earlier than 1 year after the transplant operation. For each biopsy, a single, experienced pathologist gave an estimate of both the staging according to Ishak and the degree of hepatic steatosis. The SFP was quantified in fibrosis units/month (FU/mo). The lipid metabolism status of patients was summarized by the plasma triglycerides/cholesterol (T/C) ratio. Body mass index (BMI) was measured before OLT, and 1 and 2 years after it.

RESULTS: In the HCV positive group, the highest SFP was observed in the first post-OLT year. At that time point, a SFP ≤0.100 FU/mo was observed more frequently among recipients who had received their graft from a young donor and had a pre-transplant BMI value >26.0 kg/m2. At completion of the first post-transplant year, a BMI value >26.5 kg/m2 was associated with a T/C ratio ≤1. The proportion of patients with SFP >0.100 FU/mo descended in the following order: female recipients with a high T/C ratio, male recipients with high T/C ratio, and recipients of either gender with low T/C ratio. Hepatic steatosis was observed more frequently in recipients who, in the first post-transplant year, had increased their BMI ≥1.5 kg/m2 in comparison to the pre-transplant value. Hepatic steatosis was inversely associated with the staging score.

CONCLUSION: Among HCV positive recipients, excess weight gain post-OLT does not represent a factor favoring early liver fibrosis development and might even be protective against it.

Keywords: Liver transplantation; Hepatitis C infection; Liver fibrosis; Liver steatosis; Body mass index