title: Histological and clinical outcome after liver transplantation for hepatitis C.
abstract: Hepatitis frequently recurs after liver transplantation for hepatitis C. However, the histological progression of disease, predictors of recurrence and disease severity, and patient survival remain uncertain. Fifty-five patients with cirrhosis caused by chronic hepatitis C underwent liver transplantation between January 1990 and December 1993. Hepatitis C genotype was determined, and liver biopsies were performed at frequent intervals posttransplantation. The median follow-up time was 40.4 months. The cumulative rate of survival was no different in liver transplant recipients for hepatitis C than in liver transplant recipients for other chronic liver diseases (P = .62). Histological recurrent hepatitis C developed in 33 of 50 patients assessable for disease recurrence; the median recurrence-free survival time was 13.4 months. Histological activity and stage were mild in most cases. Only 2 patients developed cirrhosis, and no patient required a second transplantation for recurrent disease. Patients with acute cellular rejection had a shorter recurrence-free survival (P = .0141). In patients with recurrent hepatitis, rejection also was correlated with increased histological grade 2 years after transplantation (P = .0061). Recurrence-free survival was decreased in patients infected with genotype 1 (1a and 1b combined) compared with genotypes 2 and 3 combined (P = .02), whereas there was no difference between genotypes 1a and 1b (P > .80). Only patients infected with genotype 1a or 1b developed bridging fibrosis or cirrhosis. In addition, patients who had an early recurrence had a greater risk of progressing to bridging fibrosis or cirrhosis (hazard ratio, 5.1; P = .0473). In our experience, recurrent hepatitiS C after liver transplantation in most cases is mild and survival is unaffected. Both acute cellular rejection and infection with genotype 1 are independent risk factors for reduced recurrence-free survival, and early recurrence is associated with a higher risk of disease progression.
authors.affiliation: Department of Medicine, University of Washington, Seattle, USA.
authors.forename: M C
authors.initials: MC
authors.lastname: Shuhart
authors.forename: M P
authors.initials: MP
authors.lastname: Bronner
authors.forename: D R
authors.initials: DR
authors.lastname: Gretch
authors.forename: L V
authors.initials: LV
authors.lastname: Thomassen
authors.forename: C F
authors.initials: CF
authors.lastname: Wartelle
authors.forename: H
authors.initials: H
authors.lastname: Tateyama
authors.forename: S S
authors.initials: SS
authors.lastname: Emerson
authors.forename: J D
authors.initials: JD
authors.lastname: Perkins
authors.forename: R L
authors.initials: RL
authors.lastname: Carithers
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D005838:Genotype; D006084:Graft Rejection / Q000473:pathology; D006085:Graft Survival; D016174:Hepacivirus / Q000235:genetics; D006526:Hepatitis C / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008099:Liver / Q000473:pathology*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood; D012008:Recurrence; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D012367:RNA, Viral