title: Good outcomes of liver transplantation for hepatitis C at a low volume centre.
abstract: OBJECTIVE
  Concerns exist about outcomes of liver transplantation (LT) from low volume centres, especially for hepatitis C (HCV) patients. The aim of the study was to assess patient outcomes as well as their predictors post LT for HCV in a small volume Australian unit (< 25 LTs/year), comparing these with the average outcomes obtained from national and international transplant registries. Patients transplanted for HCV at the South Australian Liver Transplant Unit between 1992 and 2012 were studied. Outcomes assessed were patient and graft survival at 1,3, and 5 years. Factors independently associated with the outcomes were assessed using Cox regression model.
  
  
  RESULTS
  1, 3, and 5-year patient survival for HCV patients was 95.2, 82.9, and 78.2%, graft survival were 93.7, 80.1, and 75.5% respectively. The total follow-up time observed was 299.9 years amongst 61 patients in which there were 16 deaths. The expected number of deaths was 40.4 and the standardized mortality ratio 0.40 (95% CI = 0.24, 0.65). These results compared favourably to those obtained from the SRTR registry. Variables independently associated with lower patient survival: donor age (HR = 1.06, 95% CI 1.02 - 1.11; P = 0.003), and post LT cytomegalovirus (CMV) disease requiring treatment (HR = 4.03, 95% CI 1.48 - 10.92;P = 0.06).
  
  
  CONCLUSIONS
  In conclusion, high rates of patient and graft survival for HCV liver transplantation can be obtained in a small volume unit. Young donor age and lack of CMV disease post-transplant were associated with better outcomes. Institutional factors may be influential determinants of outcomes.
authors: Hepatology and Liver Transplant Medicine Unit, Flinders Medical Centre, Adelaide, South Australia; The South Australian Liver Transplant Unit, Flinders Medical Centre, Adelaide, South Australia.
authors: Yin Lau
authors: YL
authors: Su
authors: Flinders Centre for Epidemiology and Biostatistics, School of Medicine, Flinders University of South Australia, Adelaide, South Australia.
authors: Richard J
authors: RJ
authors: Woodman
authors: The South Australian Liver Transplant Unit, Flinders Medical Centre, Adelaide, South Australia; LiverTransplant Unit, Irmandade Santa Casa de Misericordiade Porto Alegre, Brazil.
authors: Mauricio F
authors: MF
authors: Silva
authors: Hepatology and Liver Transplant Medicine Unit, Flinders Medical Centre, Adelaide, South Australia; The South Australian Liver Transplant Unit, Flinders Medical Centre, Adelaide, South Australia.
authors: Kate
authors: K
authors: Muller
authors: The South Australian Liver Transplant Unit, Flinders Medical Centre, Adelaide, South Australia.
authors: John
authors: J
authors: Libby
authors: The South Australian Liver Transplant Unit, Flinders Medical Centre, Adelaide, South Australia.
authors: John W
authors: JW
authors: Chen
authors: The South Australian Liver Transplant Unit, Flinders Medical Centre, Adelaide, South Australia.
authors: Robert
authors: R
authors: Padbury
authors: Hepatology and Liver Transplant Medicine Unit, Flinders Medical Centre, Adelaide, South Australia; The South Australian Liver Transplant Unit, Flinders Medical Centre, Adelaide, South Australia.
authors: Alan J
authors: AJ
authors: Wigg
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001315:Australia / Q000453:epidemiology; D001379:Azathioprine / Q000009:adverse effects; D016022:Case-Control Studies; D015331:Cohort Studies; D003586:Cytomegalovirus Infections / Q000139:chemically induced / Q000453:epidemiology; D006084:Graft Rejection / Q000517:prevention & control; D006085:Graft Survival; D019698:Hepatitis C, Chronic / Q000150:complications*; D061846:Hospitals, Low-Volume; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D008103:Liver Cirrhosis / Q000209:etiology / Q000601:surgery*; D016031:Liver Transplantation; D008875:Middle Aged; D011239:Prednisolone / Q000009:adverse effects; D012189:Retrospective Studies; D015996:Survival Rate; D016559:Tacrolimus / Q000009:adverse effects; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D011239:Prednisolone; D001379:Azathioprine; D016559:Tacrolimus