title: Cirrhosis of mixed etiology (hepatitis C virus and alcohol): Posttransplantation outcome-Comparison with hepatitis C virus-related cirrhosis and alcoholic-related cirrhosis.
abstract: Hepatitis C virus (HCV)-related liver disease is enhanced by alcohol consumption. Of HCV-related liver transplantation (LT) recipients, 25% have a history of alcohol intake. The purpose of this research was to determine whether LT outcome differs between patients with cirrhosis of mixed etiology compared to HCV or alcohol alone. Of 494 LT (1997-2001), recipient/donor features, post-LT histological, metabolic complications [hypertension, diabetes-diabetes mellitus (DM)], and de novo tumors were compared in 3 groups [HCV-related cirrhosis = 170 (HCV group), alcohol-related cirrhosis (alcohol group) = 107, and cirrhosis of mixed etiology (mixed group) = 60]. Protocol biopsies were done in HCV patients. Severe recurrent HCV disease was defined as: 1-year fibrosis >1, cholestatic hepatitis, recurrent cirrhosis, or HCV-related liver retransplantation (reLT) within 5 years. Patients in the mixed group were younger (mean age: HCV group = 59 years; mixed group = 49 years; alcohol group = 53 years; P < 0.05) and mainly men (% men: HCV group = 51%; mixed group = 97%; alcohol group = 87%). Hepatocellular carcinoma (HCC) was more frequent in HCV patients (HCV group = 44%; mixed group = 35%; alcohol group = 18%; P = 0.05). Five-year survival was lowest in the HCV group (HCV group = 49% versus mixed group = 73% versus alcohol group = 76%; and P < 0.01 for the HCV group versus the alcohol group or the HCV group versus the mixed group; P = 0.74 for the alcohol group versus the mixed group). Metabolic complications and de novo tumors were more frequent in the alcohol groups. Severe HCV disease was similar in the HCV+ groups (HCV group = 45%; mixed group = 45%; P = 0.66). Patients with in the mixed group were more frequently treated with antivirals (32% versus HCV group = 18%; P = 0.03). In HCV patients, factors independently associated with lower survival were older donor age, LT indication (HCV alone), and increased body mass index (BMI). Antiviral therapy was a protective factor. Post-LT survival was lower in the isolated HCV group compared to the alcohol or mixed groups despite a similar recurrence of HCV disease. A greater use of antiviral therapy in the mixed group may explain these differences. The incidence of metabolic complications and de novo tumors was greater in the alcohol groups.
authors.affiliation: Liver Surgery and Transplant Unit, Hospital La Fe de Valencia, Valencia, Spain. toyagui@hotmail.com
authors.forename: Victoria
authors.initials: V
authors.lastname: Aguilera
authors.forename: Marina
authors.initials: M
authors.lastname: Berenguer
authors.forename: Angel
authors.initials: A
authors.lastname: Rubín
authors.forename: Fernando
authors.initials: F
authors.lastname: San-Juan
authors.forename: Jose-Miguel
authors.initials: JM
authors.lastname: Rayón
authors.forename: Martín
authors.initials: M
authors.lastname: Prieto
authors.forename: José
authors.initials: J
authors.lastname: Mir
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D005260:Female; D006085:Graft Survival; D016174:Hepacivirus / Q000378:metabolism*; D006526:Hepatitis C / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000209:etiology* / Q000628:therapy*; D008104:Liver Cirrhosis, Alcoholic / Q000209:etiology* / Q000628:therapy*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents