Outcome and Prognostic Factors of Liver Transplantation in Cryptogenic Liver Cirrhosis

Abstract

Background: Cryptogenic cirrhosis (CC) is defined as cirrhosis arising without an obvious etiology of chronic liver disease, making it a complex entity to describe and investigate. It is clear from prior epidemiologic and histologic studies that various conditions can lead to a state in which clinical and histologic diagnostic features of the original disease are not uniformly evident. Moreover, studies on such a disease's post-liver transplantation (LT) clinical course are scarce. Hence, this study aimed to evaluate the clinical course of CC in LT subjects.

Method: This prospective cohort study-maintained database with accrued information on all patients who underwent LT at Shiraz University of Medical Sciences, Abu Ali Sina organ transplant center, was reviewed. All patients aged more than 18 years at the time of transplantation and with a presumptive pre-transplant diagnosis of CC were included in the study. All cases were followed prospectively for one year after LT. A total of 162 cases were entered into the study.

Results: During 1-year follow-up (mean of 308.4 ± 122.06 days), 28 (17.4%), 6 (3.7%), 5 (3.3%), and 35 (21.6%) subjects were rejected, their liver disease recurred, re-transplanted, and deceased, respectively. One year patient survival rate was 78.4%. The survival distributions for rejection were not statistically significantly different (χ2: 0.998, P: 0.318), but it was significant for corticosteroid dose (χ2: 40.446, P < 0.0001). Those who survived received lower doses of corticosteroids (P < 0.0001), had a higher proportion of receiving mycophenolic acid (P: 0.003), had lower serum levels of WBC (P: 0.006) and had a higher proportion of being positive for HBc Ab (P: 0.002). Subjects who developed rejection had lower serum levels of albumin (P: 0.001) and albumin/protein ratio (P: 0.026), a shorter diagnosis-LT interval (P: 0.028), a higher proportion in receiving MTP pulse (P: 0.019), and a higher proportion in receiving mycophenolic acid (P: 0.044). However, Cox regression multivariate analysis showed no independent variable predicting patients or graft survival.

Conclusion: The prevalence of rejection, recurrence, and survival during the first year of LT amongst CC recipients were near to the in-line studies. In addition, owing to the presence of metabolic syndrome components in our cases, it would be plausible that a proportion of our cohort might have NAFLD and NASH. However, correlation with histopathologic and liver function biomarkers was not performed.