Early high peak hepatitis C viral load levels independently predict hepatitis C-related liver failure post-liver transplantation.
The aim of this study was to examine the importance of the serum hepatitis C viral load within the first year post-liver transplant in determining posttransplant survival. A retrospective analysis of 118 consecutive hepatitis C virus-positive liver transplant recipients who received an allograft from January 1997 to September 2005 was undertaken with a median duration of follow-up of 32.4 months. Univariate and multivariate analyses were used to examine the effects of recipient, donor, surgical, and viral factors on posttransplant outcomes. A total of 620 viral load estimations were undertaken in the first 12 months following transplantation. Patient and graft survival rates at 1, 3, and 5 years were 87.8%, 79.9%, and 70.1% and 87.0%, 79.2%, and 68.2%, respectively. According to multivariate analysis, a peak viral load > or = 10(7) IU/mL (P = 0.004; hazard ratio, 8.68; 95% confidence interval, 2.04-37.02) and exposure to antirejection therapy (P = 0.05; hazard ratio, 2.26; 95% confidence interval, 1.01-5.38) were both independent predictors of diminished patient and graft survival and hepatitis C-related allograft failure. The only other independent predictor of hepatitis C virus-related outcome after transplant was azathioprine use, which was associated with improved outcomes (P = 0.04; hazard ratio, 0.25; 95% confidence interval, 0.07-0.91). A peak viral load in the first year after transplant of >10(8), 10(7) to 10(8), and <10(7) IU/mL was associated with a mean survival of 11.8, 70.6, and 89.1 months respectively (P < or = 0.03). The results emphasize the importance of high viral loads in the early posttransplant period as an independent predictor of recipient outcomes.
Shackel
Nicholas A
NA
A.W. Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia. n.shackel@centenary.usyd.edu.au
Jamias
Jade
J
Rahman
Wassim
W
Prakoso
Emilia
E
Strasser
Simone I
SI
Koorey
David J
DJ
Crawford
Michael D
MD
Verran
Deborah J
DJ
Gallagher
James
J
McCaughan
Geoffrey W
GW
D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D005355:Fibrosis / Q000150:complications / Q000628:therapy; D016174:Hepacivirus / Q000378:metabolism*; D006526:Hepatitis C / Q000821:virology*; D006801:Humans; D017093:Liver Failure / Q000628:therapy*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D019562:Viral Load