Predictors of graft and patient survival in hepatitis C virus (HCV) recipients: model to predict HCV cirrhosis after liver transplantation.
BACKGROUND
Hepatitis C virus (HCV) recurrence after liver transplantation (LT) is almost universal, but the natural history of recurrent HCV in the allograft is highly variable. Our study had two aims: 1) to assess the impact of different pre- and postLT factors on graft and patient survival in HCV transplant recipients and 2) to create a model which may predict the patients at risk for HCV-related graft cirrhosis at 5 years postLT.


METHODS
A total of 168 LTs were considered for this study. Univariate and multivariate Cox proportional hazards regression model was used, as well as logistic regression analysis to create a model of prediction of HCV cirrhosis within 5 years after LT.


RESULTS
Predictive factors for both decreased graft and patient survival included patients recently transplanted (2000-2004), induction without azathioprine, short-term therapy with mycophenolate mofetil and prednisone (< or =6 months), presence of early cholestasis, histologically proven early recurrence of hepatitis C. Recipient human leukocyte antigen DR3 positivity, presence of early cholestasis, and donor age >50 years were identified as independent predictors of graft cirrhosis within 5 years. A predictive model was established in order to calculate at 6 months a risk score for graft HCV cirrhosis within 5 years postLT using a formula that included the identified independent predictors. The area under receiver operating characteristic curve was 0.83, indicating a good ability to predict medium-term HCV allograft cirrhosis.


CONCLUSIONS
This model may be a useful tool for better identifying high-risk HCV patients who should be selected for early initiation of antiviral therapy.
Iacob
Speranta
S
Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany. speranta.iacob@icfundeni.ro
Cicinnati
Vito R
VR
Hilgard
Philip
P
Iacob
Razvan A
RA
Gheorghe
Liana S
LS
Popescu
Irinel
I
Frilling
Andrea
A
Malago
Massimo
M
Gerken
Guido
G
Broelsch
Christoph E
CE
Beckebaum
Susanne
S
D015331:Cohort Studies; D004334:Drug Administration Schedule; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D006085:Graft Survival; D015803:HLA-DR3 Antigen / Q000097:blood; D006526:Hepatitis C / Q000150:complications* / Q000601:surgery*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D015994:Incidence; D008103:Liver Cirrhosis / Q000821:virology*; D016031:Liver Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D011183:Postoperative Complications; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011241:Prednisone / Q000008:administration & dosage / Q000627:therapeutic use; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors
D015803:HLA-DR3 Antigen; D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D011241:Prednisone