Moreira et al developed the Hepatitis Aggressiveness Score (HAS) for evaluating a patient with recurrent viral hepatitis C (HCV) following liver transplant. This can help to identify a patient who may benefit from more aggressive management. The authors are from Columbia University College of Physicians and Surgeons in New York City.
Patient selection: recurrent viral hepatitis C following liver transplant
Analysis: liver biopsy
Histologic parameters:
(1) prominent ductular reaction involving portal tracts
(2) prominent ballooning or swelling of hepatocytes with lobular disarray
(3) cholestasis of any degree (at least focal canalicular cholestasis)
(4) periportal sinusoidal fibrosis
where:
• The ductular reaction mimics biliary obstruction and results in at least focal expansion of the portal tract.
|
Parameter |
Finding |
Points |
|
ductular reaction |
absent |
0 |
|
|
present |
1 |
|
ballooning/swelling |
absent |
0 |
|
|
present |
1 |
|
cholestasis |
absent |
0 |
|
|
present |
1 |
|
periportal sinusoidal fibrosis |
absent |
0 |
|
|
present |
1 |
total score =
= SUM(points for all 4 parameters)
Interpretation:
• minimum score: 0
• maximum score: 4
• The higher the score the more severe the HCV.
|
Score |
HAS |
Designation |
5 Year Survival |
Cirrhosis |
|
0 |
HAS 1 |
nonaggressive hepatitis |
80% |
100% within 2 years |
|
1 or 2 |
HAS 2 |
aggressive hepatitis |
60% (1 point), 32% (2 points) |
50% within 5 years |
|
3 or 4 |
HAS 3 |
fibrosing cholestatic hepatitis |
20% |
15% at 5 years |
Purpose: To evaluate a patient with recurrent viral hepatitis C following liver transplant using the Hepatitis Aggressiveness Score (HAS).
Specialty: Infectious Diseases, Gastroenterology
Objective: criteria for diagnosis, severity, prognosis, stage, response to therapy
ICD-10: B17.1, B18.2,
