title: The impact of disease recurrence on graft survival following liver transplantation: a single centre experience.
abstract: Many diseases that cause liver failure may recur after transplantation. A retrospective analysis of the rate and cause of graft loss of 1840 consecutive adults receiving a primary liver transplant between 1982 and 2004 was performed to evaluate the rate of graft loss from disease recurrence. The risk of graft loss from recurrent disease was greatest, when compared to primary biliary cirrhosis (PBC), in those transplanted for hepatitis C virus (HCV) [hazard ratio (HR) 11.6; 95% confidence interval (CI) 5.1-26.6], primary sclerosing cholangitis (PSC) (HR 6.0; 95% CI 2.5-14.2) and autoimmune hepatitis (AIH) (HR 4.1; 95% CI 1.3-12.6). The overall risk of graft loss was also significantly greater in HCV (HR 2.1 vs. PBC; 95% CI 1.5-3.0), PSC (HR 1.6 vs. PBC; 95% CI 1.2-2.3) and AIH (HR 1.6; 95% CI 1.0-2.4) than in PBC. There was no statistically significant difference in the risk of graft loss because of recurrent disease, when compared with PBC, for patients transplanted for alcohol related liver disease, nonalcoholic steatohepatitis and fulminant hepatic failure. Disease recurrence is a significant cause of graft loss particularly in HCV, PSC and AIH. Recurrent disease, in part, explains the increased overall risk of graft loss in these groups.
authors.affiliation: Liver Unit, Queen Elizabeth Hospital, Birmingham, UK. ian.rowe@uhb.nhs.uk
authors.forename: Ian A
authors.initials: IA
authors.lastname: Rowe
authors.forename: Kerry
authors.initials: K
authors.lastname: Webb
authors.forename: Bridget K
authors.initials: BK
authors.lastname: Gunson
authors.forename: Naimish
authors.initials: N
authors.lastname: Mehta
authors.forename: Sayeed
authors.initials: S
authors.lastname: Haque
authors.forename: James
authors.initials: J
authors.lastname: Neuberger
mesh_terms: D000328:Adult; D006085:Graft Survival; D006526:Hepatitis C / Q000601:surgery; D019693:Hepatitis, Autoimmune / Q000601:surgery; D006801:Humans; D008105:Liver Cirrhosis, Biliary / Q000601:surgery; D016031:Liver Transplantation; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors