Improving Outcomes of Liver Retransplantation: An Analysis of Trends and the Impact of Hepatitis C Infection

Ghabril, Marwan; Dickson, Rolland C.; Wiesner, Russell H.

doi:10.1111/j.1600-6143.2007.02082.x

Cited by 80 publications

(53 citation statements)

References 30 publications

(57 reference statements)

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“…86 UNOS data from 1994-2005 demonstrated that despite improved outcomes with RT overall, HCV patients continue to have worse patient and graft survival rates compared to non-HCV patients. 87 Additional variables such as increased severity of illness pre-RT may account for decreased survival in this group following RT. As a result, the role of RT in HCV+ LT recipients remains controversial due to concerns of accelerated recurrence leading to rapid graft loss.…”

Section: Retransplantation (Rt)mentioning

confidence: 99%

Management of Hepatitis C Before and After Liver Transplantation in the Era of Rapidly Evolving Therapeutic Advances

Bunchorntavakul¹,

Reddy²

2014

JCTH

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Management of hepatitis C (HCV) in liver transplantation (LT) population presents unique challenges. Suboptimal graft survival in HCV+ LT recipients is attributable to universal HCV recurrence following LT. Although eradication of HCV prior to LT is ideal for the prevention of HCV recurrence it is often limited by adverse events, particularly in patients with advanced cirrhosis. Antiviral therapy in LT candidates needs careful monitoring, and prophylaxis with HCV antibodies is ineffective. Early antiviral therapy after LT has been investigated, but no clear benefit has been demonstrated. Protocol liver biopsy is generally recommended in HCV+ LT recipients, and antiviral therapy can be considered in those with severe/ progressive HCV recurrence. Sustained virological response (SVR) can be achieved in approximately 30% of LT recipients with pegylated interferon/ribavirin (PEG-IFN/RBV) with survival benefit, but adverse effects are common. Favorable patient characteristics for response to therapy include non-1 genotype, previously untreated, low baseline HCV-RNA, and donor IL28B genotype CC. Direct acting antiviral (DAA)-based triple therapy is associated with higher rates of SVR, but with similar or slightly higher rates of side effects, and immunosuppressive regimens need to be closely monitored and adjusted during the treatment period. Notably, the safety and efficacy of HCV treatment are very likely to improve with newer generation DAA. The benefit of immunosuppressive strategy on the natural history HCV recurrence has not been well elucidated. Based upon available evidence, cyclosporine A (CSA), mycophenolate mofetil (MMF), and sirolimus appear to have a neutral or small beneficial impact on HCV recurrence. Donor interleukin 28 B (IL28B) polymorphisms appear to impact the course and treatment outcomes in recurrent HCV. Retransplantation should be considered for patients with reasonable survival probability.

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Section: Retransplantation (Rt)mentioning

confidence: 99%

Management of Hepatitis C Before and After Liver Transplantation in the Era of Rapidly Evolving Therapeutic Advances

Bunchorntavakul¹,

Reddy²

2014

JCTH

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“…Some studies have suggested HCV-infection as a risk factor of mortality [25][26][27][28]. Rosen et al [27] analyzed 1356 patients who underwent RT from the United Network for Organ Sharing (UNOS) from 1990 to 1996.…”

Section: Retransplantation In Hcv-infected Patients: General Considermentioning

confidence: 99%

“…Hepatitis C and donor age were associated with a poor prognosis on univariate analysis, but neither had enough power to be included in a predictive model. Similarly, Ghabril et al [28] have recently evaluated 1034 HCV-infected patients and 1249 non-HCV-infected patients who underwent RT between 1994 and 2005. Patient and graft survival were significantly lower for HCV-infected compared to non-HCV-infected patients who underwent RT at least 90 days after primary LT.…”

Section: Retransplantation In Hcv-infected Patients: General Considermentioning

confidence: 99%

Retransplantation in patients with hepatitis C recurrence after liver transplantation

Carrión

Navasa

Forns

2010

Journal of Hepatology

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Hepatitis C virus (HCV) infection recurs universally after liver transplantation (LT) and fibrosis progression is accelerated in the graft. Retransplantation (RT) is the only therapeutic option to achieve long-term survival in patients with decompensated cirrhosis after LT. Patient and graft survival rates after RT are inferior to those after primary LT. It is generally accepted that severe hepatitis C recurrence (cholestatic hepatitis) and forms with rapid fibrosis progression have a poor survival after RT. However, it is not clear whether rapid fibrosis progression in the first graft will be followed by the same rate of fibrosis progression in the second graft. The use of prognostic scores as screening tools has shown an improvement in survival in HCV-infected patients after RT, reaching similar survival rates as those obtained in non HCV-infected patients. Moreover, these scores can identify candidates with a high risk of mortality in whom the use of a new organ would be unreasonable. Prevention of severe hepatitis C recurrence could be the first step to avoid RT. Thus, antiviral treatment on the waiting list (if possible) and early identification and treatment of patients with severe hepatitis C recurrence may be a good strategy to avoid RT. In addition, active management of factors which can accelerate fibrosis progression (donor age, post-transplant diabetes, high dose of corticosteroids) might reduce the incidence of severe forms of hepatitis C recurrence.

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“…Moreover, other recent studies do not identify HCV recurrence as a predictor of increased mortality in comparison with other etiologies with the exception of reLT performed during the first year after primary LT (Ghobrial et al, 2002). Based on multivariate analysis it was shown that early reLT performed in HCV-positive patients is an independent predictor of morality after reLT, indicating that severe hepatitis C recurrence (such as FCH or another reason for early graft dysfunction) should be a contraindication for retransplantation (Ghabril et al, 2008). Multiple prognostic scores were implemented to facilitate decisions which reLT would be unreasonable due to compromised graft and patient survival.…”

Section: Retransplantation In Hcv Recurrencementioning

confidence: 90%

Management of Recurrent HCV and HBV Infections after Liver Transplantation

Wawrzynowicz‐Syczewska¹

2012

Liver Transplantation - Basic Issues

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Improving Outcomes of Liver Retransplantation: An Analysis of Trends and the Impact of Hepatitis C Infection

Abstract: Retransplantation (RT) in

Cited by 80 publications

References 30 publications

Management of Hepatitis C Before and After Liver Transplantation in the Era of Rapidly Evolving Therapeutic Advances

Management of Hepatitis C Before and After Liver Transplantation in the Era of Rapidly Evolving Therapeutic Advances

Retransplantation in patients with hepatitis C recurrence after liver transplantation

Management of Recurrent HCV and HBV Infections after Liver Transplantation

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