Fibrosis in One-Year Protocol Biopsies After Liver Transplantation Is Associated With Graft Loss: A Multicenter...

Subclinical inflammation and fibrosis are common after liver transplantation and are associated with progressive fibrosis and cirrhosis, which are causes of graft loss. However, the association between early inflammation and fibrosis with graft loss remains insufficiently studied. In this multicenter cohort study, protocol biopsies collected one year posttransplant were assessed for inflammation and fibrosis. Fibrosis risk was assessed in recipients with paired biopsies at 1 year and ≥ 2 years posttransplantation. Associations of inflammation and fibrosis with graft loss and mortality were assessed using Cox regression. Graft loss was defined as re-transplantation or death due to liver complications. We included 446 liver transplant recipients. One year after transplantation, 54 recipients (18%) had inflammation, and 48 (12%) had fibrosis. In multivariable analysis, fibrosis was associated with graft loss, aHR 6.72 (95% CI: 1.36-33.29). In paired biopsies, recipients with fibrosis one year after transplantation had a fivefold higher risk of fibrosis at follow-up than those without. Inflammation was not associated with graft loss or mortality, and fibrosis was not associated with mortality. To conclude, recipients with fibrosis one year after transplantation had an increased risk of graft loss. Protocol biopsies remain valuable for detecting subclinical changes, pending further research to determine the effect on graft loss prevention.