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

Abstract

Predictors of hepatitis C virus (HCV)-related liver disease posttransplantation are still unclear. The impact of HCV genotype on outcome of transplantation has been studied, but conclusions are not in agreement. The role of HCV genotype 4 on the result of liver transplantation requires further study. The aim of this study is to examine the outcome of liver transplantation for patients with HCV genotype-4 infection. The study group included 128 patients who underwent transplantation for HCV infection: 28 patients, genotype 1; 11 patients, genotype 2; 19 patients, genotype 3; and 32 patients, genotype 4. For 64 of 128 patients, genotype was known and an assessable histological specimen was available. Median interval from transplantation to biopsy was 1.92 years (range, 0.24 to 11.48 years). Twenty-six percent of HCV genotype-4 patients developed either severe fibrosis or cirrhosis versus 6.7% in the genotype non-4 group (P ‫؍‬ .04). A statistically significant greater fibrosis progression rate was observed in genotype-4 than genotype non-4 patients. In univariate and multivariate analysis, rapid liver fibrosis was associated with the presence of HCV genotype-4 infection. In addition, donor and recipient age and graft warm ischemic time also were associated with rate of fibrosis progression. Five-year cumulative rates for the development of cirrhosis or severe liver fibrosis were 84% in genotype-4 and 24% in genotype non-4 patients (P ‫؍‬ .02). Five-year survival rates for patients with genotypes 1, 2/3, and 4 were 72%, 80%, and 79%, respectively (P ‫؍‬ .8). In conclusion, 5-year survival for patients who underwent transplantation for HCV genotype-4 infection was similar to that of genotype non-4 patients; however, more severe fibrosis and rapid fibrosis progression was observed after transplantation in patients with genotype-4 infection. (Liver Transpl 2003;9:796-804.)

Natural History of Patients with Recurrent Chronic Hepatitis C Virus and Occult Hepatitis B Co-Infection after Liver Transplantation

“…The rate of fibrosis progression in our study is also lower than that reported by Firpi et al and Wali et al (39,40). This observed difference may be accounted for by the different scoring system used in these two studies, and, the fact that Wali et al analyzed liver biopsies performed at a median of 1.92 (range 0.24-11.48) years after liver transplantation rather than at a discreet time point as in this study.…”

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.…”

Controversies in the management of hepatitis C virus infection after liver transplantation

“…These factors included the development of new immunosuppressive agents, a philosophy in which less global immunosuppression was used in patients with recurrent HCV, the increased use of interferon therapy in patients before undergoing transplantation, and the use of donor organs from patients with advanced age and unstable hemodynamics. [48][49][50][51][52] Each of these factors in and of itself could have altered the natural history of recurrent HCV infection. These and other potentially important factors are listed in Table 2.…”