title: Influence of antiviral therapy in the long-term outcome of recurrent hepatitis C virus infection following liver transplantation.
abstract: BACKGROUND
  Severity of recurrent hepatitis C virus (HCV) infection in liver transplant recipients (LTR) is variable and the influence of different factors, including the administration of antiviral therapy in the long-term outcome is controversial.
  
  
  METHODS
  We analyzed the outcome of a cohort of HCV-infected LTR who were transplanted in our institution. Patients were divided into 2 groups (severe and non-severe HCV disease) depending on the presence of a fibrosis score of F ≥ 2 in the Scheuer index and/or fibrosing cholestasic hepatitis (FCH) in a graft biopsy. Risk factors were studied using logistic regression analysis. Survival of patients was estimated using Kaplan-Meier plots. A total of 146 patients were followed for a mean of 58 months.
  
  
  RESULTS
  Fifty-six (34%) patients developed severe HCV disease and showed shorter survival (P < 0.024). Donor age (odds ratio [OR]: 1.04; 95% confidence interval [CI]: 1.02-1.06) and pre-transplant viral load (VL) >10(6) UI/mL (OR: 3.5; 95% CI: 1.42-10.61) were the only factors associated with severe HCV infection. Over-immunosuppression (OR: 2.3; 95% CI: 1.2-4.41) was specifically associated with the development of FCH. Overall, patient survival in recipients who received a full course of anti-HCV therapy was higher than in patients who did not complete antiviral therapy (P = 0.004) or received no treatment (P = 0.007). Patients with non-severe HCV infection have a higher probability of receiving a full course of antiviral therapy (P = 0.033).
  
  
  CONCLUSIONS
  In conclusion, donor age, pre-transplant VL, and over-immunosuppression were associated with the long-term development of severe HCV recurrence in liver grafts. Administration of a full course of antiviral therapy was associated with better survival.
authors.affiliation: Infectious Diseases Unit, University Hospital 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre, Madrid, Spain. anagreyne@gmail.com
authors.forename: A
authors.initials: A
authors.lastname: García-Reyne
authors.forename: C
authors.initials: C
authors.lastname: Lumbreras
authors.forename: I
authors.initials: I
authors.lastname: Fernández
authors.forename: F
authors.initials: F
authors.lastname: Colina
authors.forename: M
authors.initials: M
authors.lastname: Abradelo
authors.forename: P
authors.initials: P
authors.lastname: Magan
authors.forename: R
authors.initials: R
authors.lastname: San-Juan
authors.forename: A
authors.initials: A
authors.lastname: Manrique
authors.forename: F
authors.initials: F
authors.lastname: López-Medrano
authors.forename: A
authors.initials: A
authors.lastname: Fuertes
authors.forename: M
authors.initials: M
authors.lastname: Lizasoain
authors.forename: E
authors.initials: E
authors.lastname: Moreno
authors.forename: J M
authors.initials: JM
authors.lastname: Aguado
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D005260:Female; D016174:Hepacivirus / Q000187:drug effects; D006526:Hepatitis C / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000821:virology; D006801:Humans; D008103:Liver Cirrhosis / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000821:virology; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents
keywords: HCV; antiviral treatment; hepatitis C; risk factors; transplant