Hepatitis C virus-related cirrhosis as a significant mortality factor in intention-to-treat analysis in liver transplantation.
BACKGROUND
Liver transplantation represents the gold standard for the treatment of chronic liver disease. The whole transplantation process was assessed using an intention-to-treat analysis and considering patients from the time of their inclusion on the list and throughout lengthy follow-up.


METHODS
From January 1, 1999 to June 1, 2004, 373 adults joined the waiting list for liver transplantation at our institution. The main variables analyzed were: age, gender, etiology, Model for End-stage Liver Disease score, Child-Pugh class, United Network for Organ Sharing (UNOS) status. Global survival was evaluated using intention-to-treat analysis from the time of patient inclusion in the list to the end of their late follow-up.


RESULTS
The median waiting time was 20 months (range 0.1 to 70.2). By univariate analysis, the variables significantly influencing survival when patients joined the waiting list were: encephalopathy; ascites, poor nutritional status, Child-Pugh class C, UNOS 2, hepatitis C virus (HCV) and bilirubin > 2 mg/dL. By multivariate analysis, only HCV-related cirrhosis emerged as having an independent prognostic value. By intention-to-treat analysis, the 5-year survival rate was 67% and 79% for HCV-positive and HCV-negative patients, respectively (P = .0003).


CONCLUSIONS
HCV-related cirrhosis is an independent prognostic factor for survival according to an intention-to-treat analysis. Different inclusion criteria or treatments while on the waiting list and after transplantation need to be considered in the future for HCV-positive patients.
Gringeri
E
E
Unità di Chirurgia Epatobiliare e Trapianto Epatico, Dipartimento assistenziale di Chirugia Generale e Trapianti d'Organo, Università, Azienda Ospedaliera di Padova, Padova, Italy. enrico.gringeri@unipd.it
Vitale
A
A
Brolese
A
A
Zanus
G
G
Boccagni
P
P
Neri
D
D
Valmasoni
M
M
D'Amico
F
F
Ciarleglio
F A
FA
Carraro
A
A
Pauletto
A
A
Violi
P
P
Bassi
D
D
D'Amico
F
F
D'Amico
D F
DF
Cillo
U
U
D000328:Adult; D005260:Female; D006526:Hepatitis C / Q000150:complications* / Q000401:mortality; D006801:Humans; D033182:Intention; D008103:Liver Cirrhosis / Q000401:mortality / Q000601:surgery* / Q000821:virology*; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014850:Waiting Lists