Liver transplantation for HCV cirrhosis: improved survival in recent years and increased severity of recurrent disease in female recipients: results of a long term retrospective study.
In recent years, a worsening outcome of hepatitis C virus (HCV)-positive recipients and a faster progression of recurrent disease to overt cirrhosis has been reported. Our aims were to 1) assess patient survival and development of severe recurrent disease (Ishak fibrosis score > 3) in different transplant years; and 2) model the effects of pre- and post-liver transplantation (LT) variables on the severity of recurrent disease. A multicenter retrospective analysis was conducted on 502 consecutive HCV-positive transplant recipients between January 1990 and December 2002. Protocol liver biopsies were obtained at 1, 3, 5, 7, and 10 yr post-LT in almost 90% of the patients. All 502 patients were included in the overall survival analysis, while only the 354 patients with a follow-up longer than 1 yr were considered for the analysis of predictors of disease progression. The overall Kaplan-Meier survival rates were 78.7%, 66.3%, and 58.6%, at 12, 60, and 120 months, respectively, and a trend for a better patient survival over the years emerged from all 3 centers. The cumulative probability of developing HCV-related recurrent severe fibrosis (Ishak score 4-6) in the cohort of 354 patients who survived at least 1 yr remained unchanged over the years. Multivariate analysis indicated that older donors (P = 0.0001) and female gender of recipient (P = 0.02) were the 2 major risk factors for the development of severe recurrent disease, while the adoption of antilymphocytic preparations was associated with a less aggressive course (P = 0.03). Two of these prognostic factors, donor age and recipient gender, are easily available before LT and their combination showed an important synergy, such that a female recipient not only had a much higher probability of severe recurrent disease than a male recipient but her risk increased with the increasing age of the donor, reaching almost 100% when the age of the donor was 60 or older. In conclusion, a trend for a better patient survival was observed in more recent years but the cumulative probability of developing severe recurrent disease remained unchanged. The combination of a female recipient receiving an older graft emerged as a strong risk factor for a severe recurrence.
Belli
Luca S
LS
Hepatology and Abdominal Organ Transplantation Unit, Niguarda Hospital, Milan, Italy. luca.belli@ospedaleniguarda.it
Burroughs
Andrew K
AK
Burra
Patrizia
P
Alberti
Alberto B
AB
Samonakis
Dimitrios
D
Cammà
Calogero
C
De Carlis
Luciano
L
Minola
Ernesto
E
Quaglia
Alberto
A
Zavaglia
Claudio
C
Vangeli
Marcello
M
Patch
David
D
Dhillon
Amar
A
Cillo
Umberto
U
Guido
Maria
M
Fagiuoli
Stefano
S
Giacomoni
Alessandro
A
Slim
Omar A
OA
Airoldi
Aldo
A
Boninsegna
Sara
S
Davidson
Brian R
BR
Rolles
Keith
K
Pinzello
Giovambattista
G
D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006526:Hepatitis C / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000503:physiopathology / Q000601:surgery* / Q000821:virology*; D016031:Liver Transplantation; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D013997:Time Factors; D014019:Tissue Donors