title: Effect of nonviral factors on hepatitis C recurrence after liver transplantation.
abstract: OBJECTIVE
  Hepatitis C (HCV) is now the most common indication for orthotopic liver transplantation (OLT). While graft reinfection remains universal, progression to graft cirrhosis is highly variable. This study examined donor, recipient, and operative variables to identify factors that affect recurrence of HCV post-OLT to facilitate graft-recipient matching.
  
  
  METHODS
  Retrospective review of 307 patients who underwent OLT for HCV over a 10-year period at our center. Recurrence of HCV was identified by the presence of biochemical graft dysfunction and concurrent liver biopsy showing diagnostic pathologic features. Time to recurrence was the endpoint for statistical analysis. Five donor, 6 recipient, and 2 operative variables that may affect recurrence were analyzed by univariate comparison and Cox proportional hazard regression models.
  
  
  RESULTS
  Recurrence-free survival in the 307 study patients was 69% and 34% at 1 and 5 years, respectively. Four predictive variables related to either donor or recipient characteristics were identified. Advanced donor age, prolonged donor hospitalization, increasing recipient age, and elevated recipient MELD scores were found to increase the relative risk of HCV recurrence. Examination of HLA disparity between donors and recipients demonstrated no correlation between class I or class II mismatches and recurrence-free survival.
  
  
  CONCLUSIONS
  We have identified donor and recipient characteristics that significantly predict hepatitis C recurrence following liver transplantation. These factors are identifiable before transplant and, if considered when matching donors to HCV recipients, may decrease the incidence of HCV recurrence after OLT. A change in the current national liver allocation system would be needed to realize the full value of this benefit.
authors.affiliation: Department of Surgery, Dumont-UCLA Liver Transplant Center, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Cameron
authors.forename: Rafik M
authors.initials: RM
authors.lastname: Ghobrial
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Hiatt
authors.forename: Ian C
authors.initials: IC
authors.lastname: Carmody
authors.forename: Sherilyn A
authors.initials: SA
authors.lastname: Gordon
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Farmer
authors.forename: Hasan
authors.initials: H
authors.lastname: Yersiz
authors.forename: Michael A
authors.initials: MA
authors.lastname: Zimmerman
authors.forename: Francisco
authors.initials: F
authors.lastname: Durazo
authors.forename: Steve H
authors.initials: SH
authors.lastname: Han
authors.forename: Sammy
authors.initials: S
authors.lastname: Saab
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Gornbein
authors.forename: Ronald W
authors.initials: RW
authors.lastname: Busuttil
mesh_terms: D000328:Adult; D005260:Female; D006526:Hepatitis C / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies