Risk factors in patients with rapid recurrent hepatitis C virus-related cirrhosis within 1 year after liver transplantation.
BACKGROUND
Recurrent cirrhosis (RC) due to pretransplant underlying disease leads to organ failure and subsequent death after orthotopic liver transplantation (OLT). RC occurs in up to 30% of patients with recurrent hepatitis C (HCV) within 5 years after OLT. We sought to identify early risk factors for rapid RC within the first year after OLT in HCV-positive patients.


METHODS
Among 404 liver transplanted patients at the University of Mainz between 1998 and 2008, 90 were HCV-RNA positive. To identify predictive factors for rapid RC, we compared HCV-positive patients with advanced fibrosis stages within 1 year after OLT (n = 13) with these without RC at 5 years after OLT (n = 23).


RESULTS
Overall, poorer patient survival was associated with advanced fibrosis scores in the 1-year protocol biopsy and nonresponse to interferon treatment before OLT. The strongest predictive factors for rapid RC were persistently high levels of alkaline phosphatase, bilirubin, viral load at 6 months after OLT, and multiple steroid pulse therapies. The CCR2-V64I polymorphism was not associated with rapid RC.


CONCLUSIONS
We presented a group of patients with HCV-related rapid RC within the first year after OLT to identify predictive factors for rapid fibrosis progression.
Zimmermann
T
T
First Department of Medicine, University of Mainz, Mainz, Germany.
Otto
C
C
Hoppe-Lotichius
M
M
Biesterfeld
S
S
Lautem
A
A
Knaak
M
M
Zimmermann
A
A
Barreiros
A P
AP
Heise
M
M
Schattenberg
J M
JM
Sprinzl
M F
MF
Galle
P R
PR
Otto
G
G
Schuchmann
M
M
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006526:Hepatitis C / Q000453:epidemiology* / Q000601:surgery; D006801:Humans; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000821:virology*; D008113:Liver Neoplasms / Q000601:surgery; D016031:Liver Transplantation / Q000401:mortality / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D017741:Survivors; D013997:Time Factors; D019562:Viral Load