Natural History of Clinically Compensated Hepatitis C Virus–Related Graft Cirrhosis After Liver Transplantation

Abstract

The natural history of clinically compensated hepatitis C virus (HCV) cirrhosis after liver transplantation is unknown. This information is relevant to transplant centers to improve the management of these patients and decide the optimal timing for retransplantation. The aims of the study were (1) to describe the natural history of patients with HCV-cirrhosis transplants in a center with annual liver biopsies, and (2) to determine predictors for clinical decompensation, retransplantation, and mortality rates. A total of 49 patients with HCV-graft cirrhosis, 39 clinically compensated at histologic diagnosis of cirrhosis (post-liver transplantation cirrhosis) were included and followed up for 1 year (15 days-3.5 years). All patients tested were infected with genotype 1b. Predictive variables included histologic activity index (HAI) at post-liver transplantation cirrhosis, liver function tests, age, sex, and maintenance immunosuppression. Eighteen of 39 patients developed at least 1 episode of decompensation after a median of 7.8 months (4 days-2.6 years; 93% ascites). The cumulative probability of decompensation was 8%, 17%, and 42% at 1, 6, and 12 months, respectively. Graft and patient survival rates were 100%, 85%, and 71% and 100%, 92%, and 74% at 1, 6, and 12 months, respectively. Patient survival rates dropped significantly once decompensation developed (93%, 61%, and 41% at 1, 6, and 12 months, respectively). Variables associated with decompensation, retransplantation, and mortality rate included a high Child-Pugh score (>A), low levels of albumin at post-liver transplantation cirrhosis, and a short interval between liver transplantation and post-liver transplantation cirrhosis. The natural history of clinically compensated HCV-graft cirrhosis is shortened when compared with immunocompetent patients. If retransplantation is considered, it should be performed promptly once decompensation develops. (HEPATOLOGY 2000;32:852-858.)

Recurrent hepatitis C after liver transplantation: On-treatment prediction of response to peginterferon/ribavirin therapy

“…It has been estimated that as much as 8 to 44% of untreated patients develop cirrhosis within 5 to 7 years following LT. [1][2][3] Once cirrhosis occurs, the risk of hepatic decompensation and graft loss is high over a short period of time. 16 Furthermore, the results of retransplantation for recurrent HCV has been disappointing, with a 5-year survival rate of less than 50%. 17 For these reasons it is important to optimize treatment of HCV in the LT recipients.…”

Resultados do transplante hepático em pacientes com diagnóstico pré-operatório de hepatocarcinoma

“…Entretanto, o período disponível de seguimento pós-transplante ainda é limitado para que se possa avaliar mais profundamente o impacto da recidiva viral na sobrevida desses pacientes. Sabe-se que pacientes portadores de hepatite C submetidos a transplante hepático podem apresentar sobrevida reduzida em relação a outras etiologias, devido à recurrência viral no enxerto com progressão até cirrose (2,10) .…”

“…1 Serviço de Transplante Hepático; 2 Serviço de Cirurgia do Aparelho Digestivo; 3 Serviço de Anatomia Patológica do Hospital de Clínicas da Universidade Federal do Paraná -UFPR; 4 Faculdade de Medicina da UFPR, Curitiba, PR. Endereço para correspondência: Dra.…”

The prediction of immunological dysfunction during antiviral therapy for HCV after liver transplantation: can we improve outcomes?

“…Recurrent hepatitis C usually results from repeated therapy using corticosteroid and anti-lymphocyte antibodies [1]. Based on histological evidence, 50-90 % of patients who undergo LT develop recurrent HCV within 12 months, and 20-30 % of patients develop liver cirrhosis within 5 years [2,3]. Patients with recurrent hepatitis C after LT have a 56.7 % of 5-year survival rate, which is significantly lower than that in HCV-negative patients [4,5].…”