Liver transplantation for HCV-associated liver cirrhosis: Predictors of outcomes in a population with significant genotype 3 and 4 distribution

Abstract

End-stage liver disease associated with hepatitis C virus (HCV) infection is now the leading indication for liver transplantation in adults. However, reinfection of the graft is universal. We aimed to determine predictors of outcome of HCV-liver transplant recipients in the Australian and New Zealand communities. The following variables were analysed: demographic factors, coexistent pathology at the time of transplantation, HCV genotype, and donor age. Outcomes measures were: 1. mortality; 2. development of HCV-related complications, which were stage 3 or 4 fibrosis, or mortality from HCV-related graft failure, or both. Between January 1989 and December 30, 1999, 182 patients were transplanted for HCV-associated cirrhosis. The median follow-up period was 4 years (range, 0 to 13 years). Genotype data were available on 157 patients. The distribution of genotypes among the 157 patients was as follows: 36 (23%) genotype 1a, 30 (19%) genotype 1b, 4 (9%) genotype 1, 17 (11%) genotype 2, 41 (26%) genotype 3a, and 16 (10%) genotype 4. Eight (5%) patients were HCV-polymerase chain reaction (PCR)-negative (but HCV-antibody-positive). Donor age and genotype 4 were associated with an increased risk of retransplantation or death (P < .001 and .05, respectively). Meanwhile, donor age, genotype 4, and pretransplant excess alcohol were risk factors for the development of HCV-related complications (P ‫؍‬ .004, .008, and .02, respectively). In contrast, patients with genotype 3a were less likely to develop HCV-related complications (P ‫؍‬ .05). In a population of HCV liver transplant recipients with a heterogeneous genotype distribution, donor age, and genotype 4, were predictors of a worse outcome, whereas genotype 3 was associated with a more favorable outcome. (Liver Transpl 2003;9:339-347.)

High Rate of Infection with Hepatitis C Virus Genotype 4 in a District of Galicia, Spain

“…On the other hand, studies with African and Middle Eastern populations suggest a frequent association with cirrhosis and a rapid fibrosis progression rate following liver transplantation (5,7). Although this genotype was previously categorized as difficult to treat, our results are in accordance with the more recent trials that suggest a response intermediate between those of genotype 1 and non-1 genotypes.…”

Outcome of liver transplantation for patients infected by hepatitis C, including those infected by genotype 4

“…Gane et al 9 found that 50% of HCV genotype-4 patients developed progressive liver disease. Zekry et al 35 reported that HCV genotype 4 was associated with an inferior outcome after liver transplantation. Most of those patients were from the Middle East.…”

Hepatitis C impairs survival following liver transplantation irrespective of concomitant hepatocellular carcinoma

“…Liver transplantation (LTX) is the only curative treatment for end-stage liver disease (ESLD) caused by hepatitis C (HCV) [1], and the results following orthotopic liver transplantation are considered as fully acceptable [2][3][4]. In the United States and some areas of Europe, HCV cirrhosis has been one of the leading LTX indications in recent years [5,6].…”