title: Post-transplant survival is improved for hepatitis C recipients who are RNA negative at time of liver transplantation.
abstract: Hepatitis C virus (HCV) infection recurs universally in patients who are viremic at liver transplantation and likely accounts for the diminished post-transplant graft and patient survival. We evaluated whether undetectable HCV RNA pretransplant improves graft and patient survival after transplantation. Cases, defined by HCV listing diagnosis and positive HCV antibody, were selected from the Scientific Registry of Transplant Recipients database and further grouped as HCV RNA-positive (n = 4978) or negative (n = 445) based upon pretransplant testing. Controls were non-HCV recipients (n = 2995). RNA-negative cases had significantly better 5-year graft (72% vs. 64%) and patient (79% vs. 69%) survival than RNA-positive cases (P < 0.01 for both), and similar survival as controls (Graft: 72% vs. 74%,
  
  
  METHODS
  79% vs. 80%; P > 0.05 for both). Nonproportional hazards modeling of RNA-positive cases identified a subgroup with rapid progression leading to early graft loss and death. Multivariable analyses confirmed that a positive HCV RNA prior to transplantation was a significant independent predictor of graft loss and death. In conclusion, HCV patients who have undetectable RNA at the time of liver transplantation experience improved long-term graft and patient outcomes. We speculate that the post-transplant survival of HCV recipients could be improved by safe and tolerable pretransplant antiviral strategies.
authors.affiliation: Section of Digestive Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
authors.forename: Brett E
authors.initials: BE
authors.lastname: Fortune
authors.affiliation: Division of Gastroenterology and Hepatology, University of Colorado Denver, Aurora, CO, USA.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Martinez-Camacho
authors.affiliation: Department of Radiology, University of Colorado Denver, Aurora, CO, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Kreidler
authors.affiliation: Department of Pediatrics, University of Colorado Denver, Aurora, CO, USA.
authors.forename: Jane
authors.initials: J
authors.lastname: Gralla
authors.affiliation: Division of Gastroenterology and Hepatology, University of Colorado Denver, Aurora, CO, USA.
authors.forename: Gregory T
authors.initials: GT
authors.lastname: Everson
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D016174:Hepacivirus / Q000235:genetics / Q000302:isolation & purification*; D019698:Hepatitis C, Chronic / Q000097:blood / Q000401:mortality / Q000601:surgery* / Q000821:virology; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012367:RNA, Viral / Q000097:blood*; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D012367:RNA, Viral
keywords: Scientific Registry of Transplant Recipients; graft survival; hepatitis C virus; liver transplantation; outcomes; patient survival; recurrent hepatitis C
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