title: 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.
abstract: 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.
authors: Hepatology and Abdominal Organ Transplantation Unit, Niguarda Hospital, Milan, Italy. luca.belli@ospedaleniguarda.it
authors: Luca S
authors: LS
authors: Belli
authors: Andrew K
authors: AK
authors: Burroughs
authors: Patrizia
authors: P
authors: Burra
authors: Alberto B
authors: AB
authors: Alberti
authors: Dimitrios
authors: D
authors: Samonakis
authors: Calogero
authors: C
authors: Cammà
authors: Luciano
authors: L
authors: De Carlis
authors: Ernesto
authors: E
authors: Minola
authors: Alberto
authors: A
authors: Quaglia
authors: Claudio
authors: C
authors: Zavaglia
authors: Marcello
authors: M
authors: Vangeli
authors: David
authors: D
authors: Patch
authors: Amar
authors: A
authors: Dhillon
authors: Umberto
authors: U
authors: Cillo
authors: Maria
authors: M
authors: Guido
authors: Stefano
authors: S
authors: Fagiuoli
authors: Alessandro
authors: A
authors: Giacomoni
authors: Omar A
authors: OA
authors: Slim
authors: Aldo
authors: A
authors: Airoldi
authors: Sara
authors: S
authors: Boninsegna
authors: Brian R
authors: BR
authors: Davidson
authors: Keith
authors: K
authors: Rolles
authors: Giovambattista
authors: G
authors: Pinzello
mesh_terms: 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