Retransplantation for recurrent hepatitis C: the argument against.
1. Cirrhosis from chronic hepatitis C is the most common indication for liver grafting today. The course of hepatitis C is accelerated after liver transplantation, and no current therapy reliably prevents or arrests it. 2. It is anticipated that 20% or more of hepatitis C virus-positive transplant recipients will develop allograft cirrhosis, and the only solution will be retransplantation. 3. Results of retransplantation are inferior to primary transplantation. 4. Recipient risk factors that adversely affect mortality after repeated liver grafting include age older than 50 years, renal insufficiency, and severity of hyperbilirubinemia. When present, they reduce survival after retransplantation to approximately 40% or less. 5. Retransplantation on a large scale for recurrent hepatitis C is problematic from the perspectives of outcome, resource utilization, and fairness to candidates awaiting primary grafts.
Wall
William J
WJ
Multi-Organ Transplant Program, London Health Sciences Centre, University Campus, London, Ontario, Canada. william.wall@lhs.on.ca
Khakhar
Anand
A
D006085:Graft Survival / Q000502:physiology; D006526:Hepatitis C / Q000601:surgery*; D006801:Humans; D008099:Liver / Q000821:virology; D016031:Liver Transplantation / Q000706:statistics & numerical data; D012086:Reoperation; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States