Digital image analysis of collagen assessment of progression of fibrosis in recurrent HCV after liver transplantation

Pinelopi Manousou, Andrew K. Burroughs, Emmanuel T. Sochatzis, Grazia Isgro, Andrew Hall, Anna Green, Vincenza Calvaruso, Guang Li Ma, Jeremy Gale, Gary Burgess, James O'Beirne, David Patch, Douglas Thorburn, Gioacchino Leandro, Amar Paul Dhillon

Research output: Contribution to journalArticlepeer-review


Background & Aims: Histological assessment of fibrosis progression is currently performed by staging systems which are not continuous quantitative measurements. We aimed at assessing a quantitative measurement of fibrosis collagen proportionate area (CPA), to evaluate fibrosis progression and compare it to Ishak stage progression. Methods: We studied a consecutive cohort of 155 patients with recurrent HCV hepatitis after liver transplantation (LT), who had liver biopsies at one year and were subsequently evaluated for progression of fibrosis using CPA and Ishak staging, and correlated with clinical decompensation. The upper quartile of distribution of fibrosis rates (difference in CPA or Ishak stage between paired biopsies) defined fast fibrosers. Results: Patients had 610 biopsies and a median follow-up of 116 (18-252) months. Decompensation occurred in 29 (18%) patients. Median Ishak stage progression rate was 0.42 units/year: (24 (15%) fast fibrosers). Median CPA fibrosis progression rate was 0.71%/year (36 (23%) fast fibrosers). Clinical decompensation was independently associated by Cox regression only with CPA (p = 0.007), with AUROCs of 0.81 (95% CI 0.71-0.91) compared to 0.68 (95% CI 0.56-0.81) for Ishak stage. Fast fibrosis defined by CPA progression was independently associated with histological de novo hepatitis (OR: 3.77), older donor age (OR: 1.03) and non-use/discontinuation of azathioprine before 1 year post-LT (OR: 3.85), whereas when defined by Ishak progression, fast fibrosers was only associated with histological de novo hepatitis. Conclusions: CPA fibrosis progression rate is a better predictor of clinical outcome than progression by Ishak stage. Histological de novo hepatitis, older donor age and non-use/discontinuation of azathioprine are associated with rapid fibrosis progression in recurrent HCV chronic hepatitis after liver transplantation.

Original languageEnglish
Pages (from-to)962-968
Number of pages7
JournalJournal of Hepatology
Issue number5
Publication statusPublished - May 2013


  • Collagen
  • Digital image analysis
  • Fibrosis progression
  • Liver transplantation
  • Recurrent HCV

ASJC Scopus subject areas

  • Hepatology


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