The association between hepatitis C infection and survival after orthotopic liver transplantation.
OBJECTIVE
The effect of hepatitis C viral (HCV) infection on patient and allograft survival after orthotopic liver transplantation is controversial. Hepatitis C recurrence after transplant is inevitable, but studies to date have not found a survival difference between recipients with and without HCV.


METHODS
Using data from the United Network for Organ Sharing, we performed a retrospective cohort study of 11,036 patients who underwent 11,791 liver transplants between 1992 and 1998. The hazard rates of patient and allograft survival for patients who were HCV-positive as compared with patients who were HCV-negative were assessed by proportional-hazards analysis, with adjustment for potential confounding variables, including donor, recipient, and transplant center characteristics.


RESULTS
Liver transplantation in HCV-positive recipients was associated with an increased rate of death (hazard ratio, 1.23; 95% confidence interval [CI], 1.12-1.35) and allograft failure (hazard ratio, 1.30; 95% CI, 1.21-1.39), as compared with transplantation in HCV-negative recipients. This reduction in survival persisted after adjusting for potential confounders. There was an interaction between HCV and sex (P < 0.001) with the effect of HCV on survival being most pronounced in female recipients (patient survival hazard ratio, 1.56; 95% CI, 1.35-1.81; allograft survival hazard ratio, 1.51; 95% CI, 1.34-1.70).


CONCLUSIONS
HCV infection significantly impairs patient and allograft survival after liver transplantation.
Forman
Lisa M
LM
Center for Clinical Epidemiology and Biostatistics and the Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. formanl@mail.med.upenn.edu
Lewis
James D
JD
Berlin
Jesse A
JA
Feldman
Harold I
HI
Lucey
Michael R
MR
D000328:Adult; D015331:Cohort Studies; D015987:Effect Modifier, Epidemiologic; D005260:Female; D006085:Graft Survival; D006526:Hepatitis C / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D015996:Survival Rate