title: An evaluation of long-term outcomes after liver transplantation for cryptogenic cirrhosis.
abstract: Patients with cryptogenic cirrhosis (CC) comprise a significant proportion of liver transplant recipients. Poor outcome after transplantation has been reported by some centers, with fibrosis occurring in a significant proportion of patients. Outcome of 46 patients with CC who underwent transplantation between 1989 and 1999 at King's College Hospital London were compared with time-matched recipients who underwent transplantation for hepatitis C virus (HCV) cirrhosis (n = 58) and patients with alcohol-related cirrhosis (AC, n = 53) during the same time period. Mean follow-up was 46 +/- 37 months for CC patients, 41 +/- 31 months for AC patients, and 49 +/- 31 months for HCV patients. No protocol liver biopsy specimens were obtained, and biopsies were performed only for investigation of biochemical abnormalities. Acute cellular rejection occurred in 30% of CC, 26% of AC, and 37% of HCV patients (P = NS). Overall patient and graft survival at 1 year was 85% and 80% for CC patients, 87% and 81% for AC patients, and 91% and 82% for patients with HCV (P = NS). Five-year patient and graft survival was 81% and 77% for CC patients, 60% and 48% for AC patients, and 79% and 57% for HCV patients (Log rank; P =.369). Twenty-two percent of CC patients had inflammation on last evaluable liver biopsy, compared with 25% of patients who underwent transplantation for AC and 68% of patients who underwent transplantation for HCV. No patient who underwent transplantation for CC had histologic evidence of cirrhosis on last evaluable biopsy, compared with 2% of patients who underwent transplantation for AC and 16% of patients who underwent transplantation for HCV (Chi-squared = 13.053, P =.0015). These results suggest that CC is a favorable indication for OLT and that although a proportion of patients develop inflammation in the liver allograft, this does not result in significant graft dysfunction or loss.
authors.affiliation: Institute of Liver Studies, King's College Hospital, Denmark Hill, London, England.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Heneghan
authors.forename: Teresa
authors.initials: T
authors.lastname: Zolfino
authors.forename: Paolo
authors.initials: P
authors.lastname: Muiesan
authors.forename: Bernard C
authors.initials: BC
authors.lastname: Portmann
authors.forename: Mohammed
authors.initials: M
authors.lastname: Rela
authors.forename: Nigel D
authors.initials: ND
authors.lastname: Heaton
authors.forename: John G
authors.initials: JG
authors.lastname: O'grady
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000401:mortality / Q000473:pathology; D006085:Graft Survival; D019698:Hepatitis C, Chronic / Q000401:mortality / Q000601:surgery; D006519:Hepatitis, Alcoholic / Q000401:mortality / Q000601:surgery; D006521:Hepatitis, Chronic / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008103:Liver Cirrhosis / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D016896:Treatment Outcome