Retransplantation for graft failure in chronic hepatitis C infection: a good use of a scarce resource?
OBJECTIVE
To investigate the outcome of patients with hepatitis C virus (HCV) infection undergoing liver retransplantation.


METHODS
Using the UK National Registry, patients undergoing liver transplantation for HCV-related liver disease were identified. Data on patient and graft characteristics, as well as transplant and graft survival were collected to determine the outcome of HCV patients undergoing retransplantation and in order to identify factors associated with transplant survival.


RESULTS
Between March 1994 and December 2007, 944 adult patients were transplanted for HCV-related liver disease. At the end of follow-up, 617 of these patients were alive. In total, 194 (21%) patients had first graft failure and of these, 80 underwent liver retransplantation, including 34 patients where the first graft failed due to recurrent disease. For those transplanted for HCV-related disease, the 5-year graft survival in those retransplanted for recurrent HCV was 45% [95% confidence interval (CI): 24%-64%] compared with 80% (95% CI: 62%-90%) for those retransplanted for other indications (P = 0.01 log-rank test); the 5-year transplant survival after retransplantation was 43% (95% CI: 23%-62%) and 46% (95% CI: 31%-60%), respectively (P = 0.8, log-rank test). In univariate analysis of all patients retransplanted, no factor analyzed was significantly associated with transplant survival.


CONCLUSIONS
Outcomes for retransplantation in patients with HCV infection approach agreed criteria for minimum transplant benefit. These data support selective liver retransplantation in patients with HCV infection.
Liver and Hepatobiliary Unit, University Hospital Birmingham NHS Trust, Queen Elizabeth Hospital, Birmingham, B15 2TH, UK. i.a.c.rowe@bham.ac.uk
Ian A
IA
Rowe
Kerri M
KM
Barber
Rhiannon
R
Birch
Elinor
E
Curnow
James M
JM
Neuberger
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000601:surgery*; D006085:Graft Survival; D019698:Hepatitis C, Chronic / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D040841:Resource Allocation; D012189:Retrospective Studies; D016896:Treatment Outcome; D006113:United Kingdom