[Clinical outcome after living donor liver transplantation in patients with hepatitis C virus-associated cirrhosis].
OBJECTIVE
Hepatitis C virus (HCV)-associated cirrhosis is an increasingly frequent indication for liver transplantation (LT). However, HCV recurrence is universal and this immediately occurs following LT, which endangers both the graft and patient survival. We investigated the frequency of posttransplant recurrence of HCV infection and the patient-graft survival, and we analyzed the responses to ribavirin and interferon therapy in the patients with recurrent HCV infection after living donor liver transplantation (LDLT).


METHODS
We retrospectively reviewed the clinical outcomes of 39 HCV-associated cirrhosis patients who underwent LDLT at Asan Medical Center between August 1992 and June 2006. In this study, the diagnosis of recurrent HCV was made on the basis of increased transaminases and serum HCV RNA levels greater than 10 million IU/mL because protocol liver biopsy was not performed.


RESULTS
HCV recurrence was seen in 26 of the 39 LDLT patients (66.7%). 86.7% of recurrence occurred within the first postoperative year. Antiviral treatment was used for all patients with recurrence of HCV. None of the 10 patients receiving ribavirin alone and 9 of 16 patients who received combination therapy with pegylated interferon alpha-2a plus ribavirin became HCV RNA negative and they remained persistently negative during the median follow-up of 24.9 months. Our data indicates that there is no significant factor influencing HCV recurrence except for the recipient's age. The 2-year patient survival for the HCV patients with HCC and those patients without HCC were 81.2% and 81.3%, respectively (P=0.85) and the 2-year graft survival rates were 81.2% and 68.2%, respectively (P=0.29). No patient died from HCV recurrence during the follow-up period.


CONCLUSIONS
Combination therapy with ribavirin and interferon appears to improve the outcome of recurrent HCV infected patients after LDLT.
Park
Jeong-Ik
JI
Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, Korea.
Choi
Kun Moo
KM
Lee
Sung-Gyu
SG
Hwang
Shin
S
Kim
Ki-Hun
KH
Ahn
Chul-Soo
CS
Moon
Deok-Bog
DB
Chung
Young-Hwa
YH
Lee
Yung-Sang
YS
Suh
Dong-Jin
DJ
D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005260:Female; D006085:Graft Survival; D016174:Hepacivirus / Q000187:drug effects / Q000302:isolation & purification; D019698:Hepatitis C, Chronic / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000401:mortality / Q000601:surgery* / Q000821:virology*; D008113:Liver Neoplasms / Q000401:mortality; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000627:therapeutic use; D011994:Recombinant Proteins; D012008:Recurrence; D012189:Retrospective Studies; D012254:Ribavirin / Q000627:therapeutic use; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C100416:peginterferon alfa-2a