title: Risk stratification of allograft failure secondary to hepatitis C recurrence after liver transplantation.
abstract: OBJECTIVE
  Hepatitis C virus (HCV) recurrence after liver transplantation decreases survival rates. Improved understanding of the multiple factors influencing HCV recurrence could aid decision-making for donor-recipient pairing and maximize transplant outcomes. The aim of this study was to create a model based on pretransplant variables to stratify patients at risk of HCV-related allograft failure.
  
  
  METHODS
  This retrospective study enrolled 154 liver transplant recipients with HCV at Cleveland Clinic.
  
  
  RESULTS
  Among the study population, 54 recipients (35.1%) experienced HCV recurrence, histologically defined as moderate to severe hepatitis and/or bridging fibrosis to cirrhosis. The multivariate analysis found donor age (≥60 years, P < 0.002), donor body mass index (≥30 kg/m2, P < 0.05), African American recipient (P < 0.01) and genotype 1 (P < 0.02) as risk factors for HCV-related allograft failure. When these four factors were scored as a combined index (no factor [n = 15], one factor [n = 76], two factors [n = 43] and three or more factors [n = 20]), the HCV recurrence-free survival showed good stratification according to the scores: 93.3% with no factor, 79.3% with one factor, 52.0% with two factors and 24.4% with three or more factors at 3 years after transplant (P < 0.0001). Moreover, this risk index also identified the patient group at high risk of HCV recurrence after acute rejection.
  
  
  CONCLUSIONS
  While the introduction of direct-acting antiviral agents has been changing the paradigm of HCV treatment, the natural history of recipients with HCV as shown in this study would help estimate the risk of HCV-related allograft failure in those who do not tolerate such new treatment.
authors.affiliation: Department of General Surgery, Digestive Disease Institute.|Department of Hepatobiliary Surgery.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Shiba
authors.affiliation: Department of General Surgery, Digestive Disease Institute. hashimk@ccf.org.
authors.forename: Koji
authors.initials: K
authors.lastname: Hashimoto
authors.affiliation: Department of General Surgery, Digestive Disease Institute.
authors.forename: Dympna
authors.initials: D
authors.lastname: Kelly
authors.affiliation: Department of General Surgery, Digestive Disease Institute.
authors.forename: Masato
authors.initials: M
authors.lastname: Fujiki
authors.affiliation: Department of General Surgery, Digestive Disease Institute.
authors.forename: Cristiano
authors.initials: C
authors.lastname: Quintini
authors.affiliation: Department of General Surgery, Digestive Disease Institute.
authors.forename: Federico
authors.initials: F
authors.lastname: Aucejo
authors.affiliation: Department of General Surgery, Digestive Disease Institute.
authors.forename: Teresa Diago
authors.initials: TD
authors.lastname: Uso
authors.affiliation: Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Yerian
authors.affiliation: Department of Hepatobiliary Surgery.
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Yanaga
authors.affiliation: Division of Clinical Research and Development, Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Matsushima
authors.affiliation: Department of General Surgery, Digestive Disease Institute.
authors.forename: Bijan
authors.initials: B
authors.lastname: Eghtesad
authors.affiliation: Department of General Surgery, Digestive Disease Institute.
authors.forename: John
authors.initials: J
authors.lastname: Fung
authors.affiliation: Department of General Surgery, Digestive Disease Institute.
authors.forename: Charles
authors.initials: C
authors.lastname: Miller
keywords: allograft failure; hepatitis C recurrence; liver transplantation; risk factors