title: Liver transplantation for HCV-associated liver cirrhosis: predictors of outcomes in a population with significant genotype 3 and 4 distribution.
abstract: End-stage liver disease associated with hepatitis C virus (HCV) infection is now the leading indication for liver transplantation in adults. However, reinfection of the graft is universal. We aimed to determine predictors of outcome of HCV-liver transplant recipients in the Australian and New Zealand communities. The following variables were analysed: demographic factors, coexistent pathology at the time of transplantation, HCV genotype, and donor age. Outcomes measures were: 1. mortality; 2. development of HCV-related complications, which were stage 3 or 4 fibrosis, or mortality from HCV-related graft failure, or both. Between January 1989 and December 30, 1999, 182 patients were transplanted for HCV-associated cirrhosis. The median follow-up period was 4 years (range, 0 to 13 years). Genotype data were available on 157 patients. The distribution of genotypes among the 157 patients was as follows: 36 (23%) genotype 1a, 30 (19%) genotype 1b, 4 (9%) genotype 1, 17 (11%) genotype 2, 41 (26%) genotype 3a, and 16 (10%) genotype 4. Eight (5%) patients were HCV-polymerase chain reaction (PCR)-negative (but HCV-antibody-positive). Donor age and genotype 4 were associated with an increased risk of retransplantation or death (P <.001 and.05, respectively). Meanwhile, donor age, genotype 4, and pretransplant excess alcohol were risk factors for the development of HCV-related complications (P =.004,.008, and.02, respectively). In contrast, patients with genotype 3a were less likely to develop HCV-related complications (P =.05). In a population of HCV liver transplant recipients with a heterogeneous genotype distribution, donor age, and genotype 4, were predictors of a worse outcome, whereas genotype 3 was associated with a more favorable outcome.
authors.affiliation: AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Zekry
authors.forename: P
authors.initials: P
authors.lastname: Whiting
authors.forename: D H
authors.initials: DH
authors.lastname: Crawford
authors.forename: P W
authors.initials: PW
authors.lastname: Angus
authors.forename: G P
authors.initials: GP
authors.lastname: Jeffrey
authors.forename: R T
authors.initials: RT
authors.lastname: Padbury
authors.forename: E J
authors.initials: EJ
authors.lastname: Gane
authors.forename: G W
authors.initials: GW
authors.lastname: McCaughan
mesh_terms: D000328:Adult; D000368:Aged; D000375:Aging; D005260:Female; D005838:Genotype; D006084:Graft Rejection / Q000473:pathology; D006085:Graft Survival; D016174:Hepacivirus / Q000235:genetics*; D006526:Hepatitis C / Q000150:complications* / Q000401:mortality; D006801:Humans; D007165:Immunosuppression Therapy; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000601:surgery* / Q000821:virology*; D016031:Liver Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D012086:Reoperation; D016019:Survival Analysis; D014019:Tissue Donors