title: Clinical outcome of patients infected with hepatitis C virus infection on survival after primary liver transplantation under tacrolimus.
abstract: The outcome of hepatitis C virus (HCV) infection on patient and graft survival after orthotopic liver transplantation (OLT) has been controversial. An earlier experience with a higher dose of tacrolimus (>/=0.1 mg/kg/d intravenously and >/=0.2 mg/kg/d orally) was associated with a worse clinical outcome in patients infected with HCV. The clinical outcome of 183 liver transplant recipients with end-stage liver disease (ESLD) secondary to HCV infection (HCV group) was compared with a contemporary cohort of 556 patients with HCV infection who underwent transplantation for nonviral, nonmalignant ESLD (control group). All patients were prospectively screened for anti-HCV antibodies and HCV RNA by reverse-transcriptase polymerase chain reaction. All OLT patients were receiving low-dose tacrolimus immunosuppression. Cumulative patient survival rates for the HCV group were 80% after 1 year and 75% after 3 years compared with rates of 84% and 78%, respectively, in the control group (P = .452). Primary graft survival rates at the same time intervals for the HCV group and the control group were 72% and 77.5% at 1 year and 67% and 72% at 3 years, respectively (P = .144). The incidence of re-transplantation (re-OLT) in the HCV group and the control group was 12.6% and 10.4%, respectively (P = .42). Chronic HCV infection as an indication for OLT with a lower dose of tacrolimus immunosuppression (</=0.05 mg/kg/d intravenously and </=0.1 mg/kg/d orally) is associated with a similar patient and graft survival as those without HCV infection.
authors.affiliation: University of Pittsburgh Medical Center, Department of Pathology, PA, USA.
authors.forename: F A
authors.initials: FA
authors.lastname: Casavilla
authors.forename: J
authors.initials: J
authors.lastname: Rakela
authors.forename: S
authors.initials: S
authors.lastname: Kapur
authors.forename: W
authors.initials: W
authors.lastname: Irish
authors.forename: J
authors.initials: J
authors.lastname: McMichael
authors.forename: A J
authors.initials: AJ
authors.lastname: Demetris
authors.forename: T E
authors.initials: TE
authors.lastname: Starzl
authors.forename: J J
authors.initials: JJ
authors.lastname: Fung
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D015331:Cohort Studies; D005260:Female; D006084:Graft Rejection / Q000276:immunology; D006085:Graft Survival / Q000276:immunology; D016174:Hepacivirus / Q000235:genetics; D006526:Hepatitis C / Q000276:immunology / Q000601:surgery*; D018937:Hepatitis C Antibodies / Q000097:blood; D006801:Humans; D007124:Immunoenzyme Techniques; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D016031:Liver Transplantation / Q000276:immunology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012367:RNA, Viral / Q000097:blood; D012086:Reoperation; D012189:Retrospective Studies; D020133:Reverse Transcriptase Polymerase Chain Reaction; D015996:Survival Rate; D016559:Tacrolimus / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D018937:Hepatitis C Antibodies; D007166:Immunosuppressive Agents; D012367:RNA, Viral; D016559:Tacrolimus