Retransplantation for hepatitis C: Results of a U.S. multicenter retransplant study

Abstract

It is widely perceived that outcomes are relatively poor following retransplantation (reTX) for recurrent of hepatitis C virus (HCV) infection. Transplant centers debate the utility of offering another liver to these patients. A U.S. study group was formed to retrospectively compare survival after reTX in patients with recurrent HCV (histologically proven) and those transplanted for other indications greater than 90 days after first transplantation, from 1996 to 2004. Patients were divided into 3 groups; group 1: HCV reTX (n ϭ 43), group 2: non-HCV reTX (n ϭ 73), and group 3: recurrent HCV but no reTX (n ϭ 156). They were predominantly male, Caucasian, with mean age of 47.2 yr. The commonest indications for non-HCV reTX were chronic rejection (36%), hepatic artery thrombosis (31%) and recurrent primary sclerosing cholangitis (17%). Duration of hospitalization, number of intensive care unit (ICU) days, and time interval from listing to transplantation or reTX were similar between reTX groups. The 1-yr and 3-yr survival rates after reTX were also similar for HCV reTX and non-HCV reTX groups (1 yr, 69% vs. 73%; 3 yr, 49% vs. 55%). Model for End-Stage Liver Disease (MELD) scores were not predictive of survival from reTX. However, with a MELD score of Ͼ30 in the non HCV group, survival was Ͻ50%. In the recurrent HCV not undergoing reTX group, 30% were reevaluated for reTX but only 15% were listed for reTX and the 3-yr survival was 47%. The most common reasons for not listing for reTX were recurrent HCV within 6 months (22%), fibrosing cholestatic hepatitis (19%), and renal dysfunction (9%). In conclusion, patients retransplanted for recurrent HCV had similar 1-yr and 3-yr survival when compared to patients undergoing reTX for other indications. MELD scores were not predictive of post-reTX survival. Survival was Ͻ50% in the non-HCV reTx group with MELD score of Ͼ30. Many patients with recurrent HCV are not considered for reTX and die from recurrent disease.

The natural history of hepatitis C cirrhosis after liver transplantation

“…Such was the case in only 2 of the patients for whom a gap (2.5 and 4.7 years) was found between a biopsy with a fibrosis stage less than or equal to 4 and cirrhosis. For the other 15 patients, the median time between biopsies was 9 months (range, [5][6][7][8][9][10][11][12][13][14][15][16][17][18], in which the fibrosis progressed by a median of 3 stages (range, 1-6). For those who presented decompensation, the length of time from LT to cirrhosis was 2.5 years (range, 4 months to 8 years), and the number of completed biopsies was 3.4.…”

“…15 Graft failure and cirrhosis from progressive HCV appear to be the reasons for the decrease in survival after LT. 15 Recently, the results of a multicenter study for retransplantation for HCV graft cirrhosis suggested that retransplantation may be an option in well-selected patients. 16 As this clinical story develops and treatment options for HCV after LT expand, prognostic factors for decompensation and survival will be critically important for determining the optimal timing of retransplantation for HCV. To answer these questions, a retrospective analysis was performed from an LT database that spanned 16 years at the University of Florida.…”

Donor Factors Including Donor Risk Index Predict Fibrosis Progression, Allograft Loss, and Patient Survival following Liver Transplantation for Hepatitis C Virus

“…22,23 However, these studies also demonstrate that HCV is more difficult to clear post-LT once advanced fibrosis and cirrhosis have developed, and re-transplant outcomes for recurrent HCV remain poor. 24 Our study has limitations inherent to a single center such as relatively small sample size and center specific histological interpretation. However, the availability of serial histologic data and the granularity of clinical data allow us to draw conclusions about donor and recipient interactions that would not be possible from a large database analysis.…”

Recurrencia de la enfermedad hepática primaria después del trasplante hepático

“…Este daño hepático se atribuye a un daño citopático directo del virus sobre el hepatocito 15,20,21 . La eficacia del tratamiento combinado con interferón pegilado y ribavirina es aún menor que en el resto de los enfermos con recurrencia de hepatitis C. Aunque esta complicación es infrecuente, cuando se evalúan los pacientes que necesitan retrasplante por recurrencia de la hepatitis C, el 19% es debido a una hepatitis colestásica fibrosante de la hepatitis C 22 . Desafortunadamente, un porcentaje importante de aquellos retrasplantados vuelven a presentar una hepatitis colestásica con un curso rápido a la descompensación hepática.…”