Factors differentially correlated with the outcome of liver transplantation in hcv+ and HCV- recipients.
BACKGROUND
Survival following liver transplantation for hepatitis C virus (HCV) is significantly poorer than for liver transplants performed for other causes of chronic liver disease. The factors responsible for the inferior outcome in HCV+ recipients, and whether they differ from factors associated with survival in HCV- recipients, are unknown.


METHODS
The UNOS database was analyzed to identify factors associated with outcome in HCV+ and HCV- recipients. Kaplan-Meier graft and patient survival and Cox proportional hazards analysis were conducted on 13,026 liver transplants to identify the variables that were differentially associated with outcome survival in HCV- and HCV+ recipients.


RESULTS
Of the 13,026 recipients, 7386 (56.7%) were HCV- and 5640 were HCV+. In HCV- and HCV+ recipient populations, five-year patient survival rates were 83.5% vs. 74.6% (P<0.00001) and five-year graft survival rates 80.6% vs. 69.9% (P<0.00001), respectively. In a multivariate regression model, donor age and recipient creatinine were observed to be significant covariates in both groups, while donor race, cold ischemia time (CIT), female to male transplants, and recipient albumin were independent predictors of survival of HCV- recipients. In the HCV+ cohort, recipient race, warm ischemia time (WIT), and diabetes also independently predicted graft survival.


CONCLUSIONS
A number of parameters are differentially correlated with outcome in HCV- and HCV+ recipients of orthotopic liver transplantation. These findings may not only have practical implications in the selection and management of liver transplant patients, but also may shed new insight into the biology of HCV infection posttransplant.
Velidedeoglu
Ergun
E
Department of Surgery, University of Pennsylvania Hospital, 4th Floor Silverstein, 3400 Spruce Street, Philadelphia, PA 19104, USA.
Mange
Kevin C
KC
Frank
Adam
A
Abt
Peter
P
Desai
Niraj M
NM
Markmann
Joseph W
JW
Reddy
Rajender
R
Markmann
James F
JF
D000367:Age Factors; D005260:Female; D006085:Graft Survival / Q000502:physiology; D006526:Hepatitis C / Q000601:surgery*; D006650:Histocompatibility Testing; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D044469:Racial Groups; D012189:Retrospective Studies; D016019:Survival Analysis; D014019:Tissue Donors / Q000706:statistics & numerical data; D018183:Transplantation Chimera