title: Analysis of the recurrence of hepatitis C virus after liver transplantation: results of the Andalusian liver registry.
abstract: OBJECTIVE
  This study analyzed the factors related to recurrence of hepatitis C virus (HCV) among orthotopic liver transplantation (OLT) patients.
  
  
  METHODS
  We undertook a multicenter, prospective, observational study of OLT patients transplanted due to HCV at four Andalusian transplantation centers from 2005 to 2007. Patients were excluded if their survival was less than 1 month. The analysis included 110 pre-, peri-, and posttransplant variables that could affect HCV recurrence. We also examined the influence of cardiovascular risk factors and immunosuppression on HCV.
  
  
  RESULTS
  Among 121 HCV patients, 83 (69%) experienced a histologically significant recurrence of HCV, including 13 (16%) who died compared with 5 of 38 (13%) who did not show a severe recurrence of HCV (P = .3). The mean follow-up was 44 months (range, 4 to 64 months). The mean time to appearance of the relapse was 9 months (range, 1 to 40 months) with no differences according to the type of immunosuppression. Of all study variables, donor age (> 52 years) showed a trend for greater recurrence (P = .1). The use of powerful immunosuppression (three or more drugs), either as induction or as sustained therapy, during the first posttransplantation year was significantly associated with a greater relapse rate (P < .01), albeit with no significant difference according to the type of calcineurin inhibitor. Mycophenolate mofetil was not associated with a greater posttransplantation viral load or earlier relapse, although its use in multiple immunosuppression schedules was associated with a greater relapse rate (P < .01). Survival of patients with recurrent HCV was reduced, although not significantly. Multivariate analysis showed a 4.4 times greater risk for developing de novo diabetes mellitus (DM) among patients with a severe relapse of HCV.
  
  
  CONCLUSIONS
  There was an important trend toward a greater recurrence rate of HCV among patients who received powerful immunosuppression protocols, particularly during the first 12 months. Special attention should be given to the risk for de novo DM among HCV-positive patients.
authors: Hepatology and Liver Transplantation Units, Carlos Haya University Hospital, Málaga, Spain. mjimenezp@commalaga.com
authors: M
authors: M
authors: Jiménez-Pérez
authors: D M
authors: DM
authors: García
authors: R G
authors: RG
authors: Grande
authors: J A P
authors: JA
authors: Daga
authors: L B
authors: LB
authors: Pulido
authors: M D M E
authors: MD
authors: Aguilar
authors: M A G
authors: MA
authors: Bravo
authors: J M R
authors: JM
authors: López
authors: M M
authors: MM
authors: de la Mata Garcia
mesh_terms: D002318:Cardiovascular Diseases / Q000473:pathology; D016174:Hepacivirus; D006526:Hepatitis C / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D017093:Liver Failure / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D016031:Liver Transplantation / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012042:Registries; D012307:Risk Factors; D013030:Spain; D013997:Time Factors
chemical_list: D007166:Immunosuppressive Agents