Factors that identify survival after liver retransplantation for allograft failure caused by recurrent hepatitis C infection.
Hepatitis C virus (HCV) is becoming the most common indication for liver retransplantation (ReLTx). This study was a retrospective review of the medical records of liver transplant patients at our institution to determine factors that would identify the best candidates for ReLTx resulting from allograft failure because of HCV recurrence. The patients were divided into 2 groups on the basis of indication for initial liver transplant. Group 1 included ReLTx patients whose initial indication for LTx was HCV. Group 2 included patients who received ReLTx who did not have a history of HCV. We defined chronic allograft dysfunction (AD) as patients with persistent jaundice (> 30 days) beginning 6 months after primary liver transplant in the absence of other reasons. HCV was the primary indication for initial orthotopic liver transplantation (OLT) in 491/1114 patients (44%) from July 1996 to February 2004. The number of patients with AD undergoing ReLTx in Groups 1 and 2 was 22 and 12, respectively. The overall patient and allograft survival at 1 year was 50% and 75% in Groups 1 and 2, respectively (P = .04). The rates of primary nonfunction and technical problems after ReLTx were not different between the groups. However, the incidence of recurrent AD was higher in Group 1 at 32% versus 17% in Group 2 (P = .04). Important factors that predicted a successful ReLTx included physical condition at the time of ReLTx (P = .002) and Child-Turcotte-Pugh score (P = .008). In conclusion, HCV is associated with an increased incidence of chronic graft destruction with a negative effect on long-term results after ReLTx. The optimum candidate for ReLTx is a patient who can maintain normal physical activity. As the allograft shortage continues, the optimal use of cadaveric livers continues to be of primary importance. The use of deceased donor livers in patients with allograft failure caused by HCV remains a highly controversial issue.
Neff
Guy W
GW
University of Cincinnati, Ohio, USA. neffgw@ucmail.uc.edu <neffgw@ucmail.uc.edu>
O'Brien
Christopher B
CB
Nery
Jose
J
Shire
Norah J
NJ
Nishida
Seigo
S
delaGarza
Julia
J
Montalbano
Marzia
M
Safdar
Kamran
K
Ruiz
Phillip
P
Rideman
Eric
E
Gascon
Jose A
JA
Tzakis
Andreas G
AG
Madariaga
Juan
J
Rudich
Steven M
SM
D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D002908:Chronic Disease; D003661:Decision Support Techniques; D005260:Female; D006526:Hepatitis C / Q000150:complications* / Q000503:physiopathology / Q000601:surgery* / Q000821:virology; D006801:Humans; D007565:Jaundice / Q000209:etiology / Q000601:surgery* / Q000821:virology*; D008107:Liver Diseases / Q000150:complications / Q000503:physiopathology / Q000601:surgery; D016031:Liver Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011379:Prognosis; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D019562:Viral Load
D000998:Antiviral Agents