title: Retransplantation for hepatitis C: results of a U.S. multicenter retransplant study.
abstract: It is widely perceived that outcomes are relatively poor following retransplantation (reTX) for recurrent of hepatitis C virus (HCV) infection. Transplant centers debate the utility of offering another liver to these patients. A U.S. study group was formed to retrospectively compare survival after reTX in patients with recurrent HCV (histologically proven) and those transplanted for other indications greater than 90 days after first transplantation, from 1996 to 2004. Patients were divided into 3 groups; group 1: HCV reTX (n = 43), group 2: non-HCV reTX (n = 73), and group 3: recurrent HCV but no reTX (n = 156). They were predominantly male, Caucasian, with mean age of 47.2 yr. The commonest indications for non-HCV reTX were chronic rejection (36%), hepatic artery thrombosis (31%) and recurrent primary sclerosing cholangitis (17%). Duration of hospitalization, number of intensive care unit (ICU) days, and time interval from listing to transplantation or reTX were similar between reTX groups. The 1-yr and 3-yr survival rates after reTX were also similar for HCV reTX and non-HCV reTX groups (1 yr, 69% vs. 73%; 3 yr, 49% vs. 55%). Model for End-Stage Liver Disease (MELD) scores were not predictive of survival from reTX. However, with a MELD score of >30 in the non HCV group, survival was <50%. In the recurrent HCV not undergoing reTX group, 30% were reevaluated for reTX but only 15% were listed for reTX and the 3-yr survival was 47%. The most common reasons for not listing for reTX were recurrent HCV within 6 months (22%), fibrosing cholestatic hepatitis (19%), and renal dysfunction (9%). In conclusion, patients retransplanted for recurrent HCV had similar 1-yr and 3-yr survival when compared to patients undergoing reTX for other indications. MELD scores were not predictive of post-reTX survival. Survival was <50% in the non-HCV reTx group with MELD score of >30. Many patients with recurrent HCV are not considered for reTX and die from recurrent disease.
authors.affiliation: Department of Hepatology, University of Nebraska Medical Center, Omaha, NE 68198-3285, USA. tmccashland@unmc.edu
authors.forename: Timothy
authors.initials: T
authors.lastname: McCashland
authors.forename: Kymberly
authors.initials: K
authors.lastname: Watt
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Lyden
authors.forename: Leon
authors.initials: L
authors.lastname: Adams
authors.forename: Michael
authors.initials: M
authors.lastname: Charlton
authors.forename: Alastair D
authors.initials: AD
authors.lastname: Smith
authors.forename: Brendan M
authors.initials: BM
authors.lastname: McGuire
authors.forename: Scott W
authors.initials: SW
authors.lastname: Biggins
authors.forename: Guy
authors.initials: G
authors.lastname: Neff
authors.forename: James R
authors.initials: JR
authors.lastname: Burton
authors.forename: Hugo
authors.initials: H
authors.lastname: Vargas
authors.forename: John
authors.initials: J
authors.lastname: Donovan
authors.forename: James
authors.initials: J
authors.lastname: Trotter
authors.forename: Thomas
authors.initials: T
authors.lastname: Faust
mesh_terms: D002423:Cause of Death; D015331:Cohort Studies; D005006:Ethnicity; D005260:Female; D006526:Hepatitis C / Q000401:mortality / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D016019:Survival Analysis; D014019:Tissue Donors / Q000706:statistics & numerical data; D014481:United States; D014850:Waiting Lists