Liver retransplantation for hepatitis C virus recurrence: a survey of liver transplant programs in the United States.
OBJECTIVE
Hepatitis C virus (HCV)-related liver failure is the leading indication for liver transplantation (LT). The number requiring re-LT is expected to grow as patients live long enough to develop graft failure and recurrent disease. Numerous factors have been identified as influencing survival after re-LT. To gain insight into how transplant centers are dealing with this issue and whether published prognostic factors are being used, we conducted a survey of liver transplant centers across the US in late 2003.


METHODS
Surveys consisting of 6 multiple-choice questions were sent to all 96 adult transplant medical directors in the U.S.


RESULTS
Fifty-five (57%) surveys were returned. Of these respondents, 95% would offer re-LT for allograft failure caused by recurrent HCV. A little more than half believed age >60 years and development of allograft cirrhosis after <2 years should exclude a patient from re-LT. However, less than half thought international normalized ratio (INR), Model for End-Stage Liver Disease (MELD), and bilirubin were important factors. After initial LT, 40% of the respondents do not have a protocol for managing HCV recurrence, and 33% responded that they treat only those who develop severe recurrence. In contrast, for re-LT, 67% preemptively treat HCV recurrence. Compared to 5 years ago, 75% believe practice patterns have changed in respect to retransplanting patients with HCV: Most were less likely to offer re-LT because of associated poor long-term survival in these patients.


CONCLUSIONS
As of late 2003, nearly all surveyed transplant medical directors in the U.S. would offer re-LT to recurrent HCV. Perceived practice patterns for re-LT are at variance with published outcome data.
Burton
James R
JR
Division of Gastroenterology/Hepatology, Oregon Health & Science University and Portland Veterans Administration Medical Center, Portland, Oregon 97239, USA. burtonj@ohsu.edu
Rosen
Hugo R
HR
D019538:Health Care Surveys; D006526:Hepatitis C / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation / Q000706:statistics & numerical data*; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D012008:Recurrence; D012086:Reoperation / Q000706:statistics & numerical data; D017211:Treatment Failure; D014481:United States