A 10-Year Experience of Liver Transplantation for Hepatitis C: Analysis of Factors Determining Outcome in Over 500 Patients

Abstract

ObjectiveTo determine the factors affecting the outcome of orthotopic liver transplantation (OLT) for end-stage liver disease caused by hepatitis C virus (HCV) and to identify models that predict patient and graft survival. Summary Background DataThe national epidemic of HCV infection has become the leading cause of hepatic failure that requires OLT. Rapidly increasing demands for OLT and depleted donor organ pools mandate appropriate selection of patients and donors. Such selection should be guided by a better understanding of the factors that influence the outcome of OLT. MethodsThe authors conducted a retrospective review of 510 patients who underwent OLT for HCV during the past decade. Seven donor, 10 recipient, and 2 operative variables that may affect outcome were dichotomized at the median for univariate screening. Factors that achieved a probability value less than 0.2 or that were thought to be relevant were entered into a stepdown Cox proportional hazard regression model. ResultsOverall patient and graft survival rates at 1, 5, and 10 years were 84%, 68%, and 60% and 73%, 56%, and 49%, respectively. Overall median time to HCV recurrence was 34 months after transplantation. Neither HCV recurrence nor HCV-positive donor status significantly decreased patient and graft survival rates by Kaplan-Meier analysis. However, use of HCVpositive donors reduced the median time of recurrence to 22.9 months compared with 35.7 months after transplantation of HCV-negative livers. Stratification of patients into five subgroups, based on time of recurrence, revealed that early HCV recurrence was associated with significantly increased rates of patient death and graft loss. Donor, recipient, and operative variables that may affect OLT outcome were analyzed. On univariate analysis, recipient age, serum creatinine, donor length of hospital stay, donor female gender, United Network for Organ Sharing (UNOS) status of recipient, and presence of hepatocellular cancer affected the outcome of OLT. Elevation of pretransplant HCV RNA was associated with an increased risk of graft loss. Of 15 variables considered by multivariate Cox regression analysis, recipient age, UNOS status, donor gender, and log creatinine were simultaneous significant predictors for patient survival. Simultaneously significant factors for graft failure included log creatinine, log alanine transaminase, log aspartate transaminase, UNOS status, donor gender, and warm ischemia time. These variables were therefore entered into prognostic models for patient and graft survival.

Poor survival after liver retransplantation: Is hepatitis C to blame?

“…[13][14][15]29,30 However, in 1997, Markmann et al 15 published single-center data and reported survival rates of 52% at 1 year and 42% at 5 years in adults undergoing re-OLT between 1984 and 1996. In comparison, we show survival rates of 67% at 1 year and 52% at 5 years in adults undergoing re-OLT between 1996 and 2002.…”

Impact of donor age on survival and fibrosis progression in patients with hepatitis C undergoing liver transplantation using HCV+ allografts

“…Through randomized, blinded fashion we matched each case with its corresponding control based on specific characteristics that previous studies have demonstrated to most likely influence clinical outcomes. 18,21 In order of importance, these variables included donor age (within 10 yr), year of transplantation (within 4 yr), United Network for Organ Sharing/Model for End-Stage Liver Disease score, and recipient age (within 20 yr). Donor age has shown to impact survival after liver transplantation in HCV and thus was chosen as a matching variable.…”

Retransplantation for recurrent hepatitis C: Positive aspects

“…6 The University of California at Los Angeles (UCLA) group noted the median time to recurrence was 34 months posttransplantation, with 68% having recurrent hepatitis at 5-year follow-up. 9 A recent study has evaluated the histologic changes in patients in whom cirrhosis developed after transplantation. 10 Eighty percent of these patients had recurrent disease within 6 months.…”

“…Of concern, Ghobrial and others reported death risk ratios of 12.4, 4.2, 5.5, and 1.7 in patients who had HCV recurrence within the first 12, 12 to 24, 24 to 36, and more than 36 months after transplantation. 9 Interestingly, many studies note that hepatitis C patients compared with controls have not shown a reduced graft or patient survival. [11][12][13] Recently, Forman et al, using the data from UNOS, reported that HCV-positive recipients were associated with an increased rate of death (hazard ratio, 1.23), especially in female recipients, compared with non-HCV recipients.…”