Assessment of disease progression in patients with transfusion-associated chronic hepatitis C using transient elastography

Abstract

Aim: To evaluate the relationship between liver stiffness and duration of infection in blood transfusion-associated hepatitis C virus (HCV) patients with or without hepatocellular carcinoma (HCC).

Methods: Between December 2006 and June 2008, a total of 524 transfusion-associated HCV-RNA positive patients with or without HCC were enrolled. Liver stiffness was obtained noninvasively by using Fibroscan (Echosens, Paris, France). The date of blood transfusion was obtained by interview. Duration of infection was derived from the interval between the date of blood transfusion and the date of liver stiffness measurement (LSM). Patients were stratified into four groups based on the duration of infection (17-29 years; 30-39 years; 40-49 years; and 50-70 years). The difference in liver stiffness between patients with and without HCC was assessed in each group. Multiple linear regression analysis was used to determine the factors associated with liver stiffness.

Results: A total of 524 patients underwent LSM. Eight patients were excluded because of unsuccessful measurements. Thus 516 patients were included in the current analysis (225 with HCC and 291 without). The patients were 244 men and 272 women, with a mean age of 67.8 ± 9.5 years. The median liver stiffness was 14.3 kPa (25.8 in HCC group and 7.6 in non-HCC group). The patients who developed HCC in short duration of infection were male dominant, having lower platelet count, with a history of heavier alcohol consumption, showing higher liver stiffness, and receiving blood transfusion at an old age. Liver stiffness was positively correlated with duration of infection in patients without HCC (r = 0.132, P = 0.024) but not in patients with HCC (r = -0.103, P = 0.123). Liver stiffness was significantly higher in patients with HCC than in those without in each duration group (P < 0.0001). The factors significantly associated with high liver stiffness in multiple regression were age at blood transfusion (P < 0.0001), duration of infection (P = 0.0015), and heavy alcohol consumption (P = 0.043).

Conclusion: Although liver stiffness gradually increases over time, HCC develops in patients with high stiffness value regardless of the duration of infection.

Keywords: Hepatocellular carcinoma; Liver fibrosis; Liver stiffness; Transfusion-associated hepatitis C; Transient elastography; Ultrasonography.

Figure 1

Frequency distribution of the year of receiving blood transfusion among the subjects. There is a peak around the year 1960.

Figure 2

Duration of infection and liver stiffness. Liver stiffness was higher in patients with HCC than in patients without in each infection duration group (^aP < 0.0001 by Mann-Whitney U test).

Figure 3

Age at blood transfusion and liver stiffness. Stiffness at present (each dot) and stiffness at BTF (assumed to normal value) were connected approximate logarithmic curve. Stiffness progressions become rapid in older age at BTF.

Figure 4

Liver stiffness progression rate. The progression rate is significantly higher in patients who were older than 40 at the time of blood transfusion, whose alcohol consumption is more than 50 g/d, and who are male. There is no significant difference according to hepatitis C virus (HCV) serotypes. Horizontal bar represents median value and 25th-75th percentiles.