title: Positive serum cryoglobulin is associated with worse outcome after liver transplantation for chronic hepatitis C.
abstract: BACKGROUND
  Recurrent hepatitis C virus (HCV) infection in patients after liver transplantation is an important clinical problem. Because serum cryoglobulins (CG) are known to be associated with an increased incidence of cirrhosis in nontransplant patients, the authors tested the hypothesis that CG would also predict aggressive recurrent HCV in patients after liver transplantation.
  
  
  METHODS
  Using a longitudinal database, the outcomes of 105 allografts transplanted into 97 HCV-positive patients from 1991 through 2002 were analyzed on the basis of CG status using a retrospective cohort design. Fifty-nine CG-negative and 38 CG-positive patients were identified. Histologic outcomes and graft survival were analyzed using Kaplan-Meier estimates and Cox univariate and multivariate analyses. Both overall survival and HCV-specific survival (non-HVC-related deaths and graft losses censored) were analyzed.
  
  
  RESULTS
  By Kaplan-Meier estimates, CG-positive patients showed earlier graft failure with decreased time to severe histologic activity and fibrosis as compared with CG-negative patients (P<0.05 for all outcomes). By univariate analysis, CG-positive patients had significantly higher risk ratios for shortened HCV-specific graft survival, severe activity-free survival, and severe fibrosis-free survival as compared with CG-negative patients (P<0.05 for all outcomes). In the multivariate model, CG was an independent predictor for severe activity-free, severe fibrosis-free, and HCV-specific graft survival (P<0.05 for all outcomes).
  
  
  CONCLUSIONS
  CG-positivity is associated with severe recurrent HCV disease in liver transplant recipients.
authors.affiliation: Department of Surgery, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA. rayhills@ohsu.edu
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Rayhill
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Kirby
authors.forename: Michael D
authors.initials: MD
authors.lastname: Voigt
authors.forename: Douglas R
authors.initials: DR
authors.lastname: La Brecque
authors.forename: Charles T
authors.initials: CT
authors.lastname: Lutz
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Katz
authors.forename: Frank A
authors.initials: FA
authors.lastname: Mitros
authors.forename: Roberto S
authors.initials: RS
authors.lastname: Kalil
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Miller
authors.forename: Alan H
authors.initials: AH
authors.lastname: Stolpen
authors.forename: Dennis
authors.initials: D
authors.lastname: Heisey
authors.forename: You Min
authors.initials: YM
authors.lastname: Wu
authors.forename: Warren N
authors.initials: WN
authors.lastname: Schmidt
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D003450:Cryoglobulins / Q000378:metabolism*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D016174:Hepacivirus / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000097:blood / Q000473:pathology / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012367:RNA, Viral / Q000235:genetics; D012008:Recurrence; D012189:Retrospective Studies; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012307:Risk Factors; D012720:Severity of Illness Index; D014184:Transplantation, Homologous
chemical_list: D015415:Biomarkers; D003450:Cryoglobulins; D012367:RNA, Viral