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Transplantation Outcomes in Patients with Hepatitis C

Hepatitis C virus (HCV) is a frequent cause of chronic liver disease, and HCV infection is the most common reason for liver transplantation. Better testing for HCV has improved diagnostic accuracy and shown a high frequency of HCV recurrence after transplantation that may lead to graft failure. Because organs for transplant are in limited supply, disease severity and expected outcomes should be considered when evaluating recipient candidates. Ghobrial and associates retrospectively studied the long-term clinical outcomes of patients who received a first-time transplant for end-stage HCV-induced liver disease.

Of the 510 patients included in the 10-year study period, 80 required retransplantation. Of the first-time transplant recipients, 59 received livers from persons known to be HCV-positive. All patients received maintenance immunosuppression. Patient survival rates were 84 percent at one year, 68 percent at five years, and 60 percent at 10 years, with higher mortality rates in patients with early HCV recurrence. These results are comparable with those occurring in patients who undergo liver transplantation for other indications. General survival rates and graft survival rates in patients who received a transplant from an HCV-positive donor were not different from those in patients with HCV-negative donors, although the period to histologic recurrence is shorter when an HCV-positive liver is used.

Factors associated with increased risk of patient death after transplantation and with graft failure are listed in the accompanying table. Increased pretransplant prothrombin time protected against graft failure.

Mortality and Risk Factors* in Transplants for HCV-induced Hepatic Failure Risk factors for decreased recipient survival Increased age of recipient (>52 years of age) Preoperative serum creatinine level >1 mg per dL (0.02 mmol per L) More urgent UNOS status Donor was female Risk factors for decreased graft survival Donor was female Preoperative serum creatinine level >1 mg per dL Increased AST, ALT levels More urgent UNOS status Increased warm ischemia time HCV = hepatitis C virus; UNOS = United Network for Organ Sharing; AST = aspartate transaminase; ALT = alanine transaminase. *--Risk factors analyzed using univariate analysis. Information from Ghobrial RM, Steadman R, Gornbein J, Lassman C, Holt CD, Chen P, et al. A 10-year experience of liver transplantation for hepatitis C: analysis of factors determining outcome in over 500 patients. Ann Surg 2001;234:384-94.

The authors conclude that models can be developed to predict patient and graft survival in patients receiving liver transplants for HCV-related liver failure. These models may help current organ distribution systems to make appropriate decisions.

RICHARD SADOVSKY, M.D.

Ghobrial RM, et al. A 10-year experience of liver transplantation for hepatitis C: analysis of factors determining outcome in over 500 patients. Ann Surg September 2001; 234:384-94.