title: Viral status at the time of liver transplantation for hepatocellular carcinoma: a modern predictor of longterm survival.
abstract: OBJECTIVE
  The impact of pre-transplant hepatitis B virus (HBV) and/or hepatitis C virus (HCV) infection in patients with hepatocellular carcinoma (HCC) is not well described. This study was conducted to test the hypothesis that viral status is an independent predictor of retransplantation rates, graft survival (GS) and overall survival (OS) in patients undergoing liver transplantation for HCC.
  
  
  METHODS
  Patients with HCC were identified from the Organ Procurement and Transplantation Network database (2005-2012), and categorized by viral status according to these categories: HBV-/HCV-; HBV+/HCV-; HBV-/HCV+, and HBV+/HCV+.
  
  
  RESULTS
  Of 7742 patients transplanted for HCC, 7060 had known HBV and HCV status. Five-year GS and OS were highest in recipients who were HBV+/HCV-, at 75% and 78%, respectively, compared with patients who were HBV-/HCV- (GS = 63%, OS = 66%), HBV-/HCV+ (GS = 64%, OS = 60%) or HBV+/HCV+ (GS = 60%, OS = 62%). In multivariable analyses, HBV-/HCV+ patients were more likely than HBV+/HCV- patients to undergo repeat transplantation. Patients who were HBV-/HCV+ also had poorer GS and OS than both HBV-/HCV- and HBV+/HCV- patients. Other independent predictors of poorer OS included older age, higher Model for End-stage Liver Disease score, African-American race, and diabetes. The few HBV+/HCV+ patients (n = 138) showed trends toward fewer retransplantations, prolonged GS and prolonged OS compared with HBV-/HCV+ patients. In adjusted models, antiviral medications did not impact GS or OS.
  
  
  CONCLUSIONS
  In the era of modern selection criteria, viral status is an independent predictor of outcome following liver transplantation for HCC. Both HBV-/HCV- and HBV+/HCV- patients have superior GS and OS compared with HBV-/HCV+ patients.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Ryan T
authors.initials: RT
authors.lastname: Groeschl
authors.forename: Johnny C
authors.initials: JC
authors.lastname: Hong
authors.forename: Kathleen K
authors.initials: KK
authors.lastname: Christians
authors.forename: Kiran K
authors.initials: KK
authors.lastname: Turaga
authors.forename: Susan
authors.initials: S
authors.lastname: Tsai
authors.forename: Charles H C
authors.initials: CH
authors.lastname: Pilgrim
authors.forename: T Clark
authors.initials: TC
authors.lastname: Gamblin
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery* / Q000821:virology; D005260:Female; D006085:Graft Survival; D006509:Hepatitis B / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D006526:Hepatitis C / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery* / Q000821:virology; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012042:Registries; D012086:Reoperation; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome