title: Predictive factors for survival and score application in liver retransplantation for hepatitis C recurrence.
abstract: OBJECTIVE
  To identify risk factors associated with survival in patients retransplanted for hepatitis C virus (HCV) recurrence and to apply a survival score to this population.
  
  
  METHODS
  We retrospectively identified 108 patients retransplanted for HCV recurrence in eight European liver transplantation centers (seven in France, one in Spain). Data collection comprised clinical and laboratory variables, including virological and antiviral treatment data. We then analyzed the factors associated with survival in this population. A recently published score that predicts survival in retransplantation in patients with hepatitis C was applied. Because there are currently no uniform recommendations regarding selection of the best candidates for retransplantation in this setting, we also described the clinical characteristics of 164 patients not retransplanted, with F3, F4, or fibrosing cholestatic hepatitis (FCH) post-first graft presenting with hepatic decompensation.
  
  
  RESULTS
  Overall retransplantation patient survival rates were 55%, 47%, and 43% at 3, 5, and 10 years, respectively. Patients who were retransplanted for advanced cirrhosis had survival rates of 59%, 52%, and 49% at 3, 5, and 10 years, while those retransplanted for FCH had survival rates of 34%, 29%, and 11%, respectively. Under multivariate analysis, and adjusting for the center effect and the occurrence of FCH, factors associated with better survival after retransplantation were: negative HCV viremia before retransplantation, antiviral therapy after retransplantation, non-genotype 1, a Model for End-stage Liver Disease (MELD) score < 25 when replaced on the waiting list, and a retransplantation donor age < 60 years. Although the numbers were small, in the context of the new antivirals era, we showed that outcomes in patients who underwent retransplantation with undetectable HCV viremia did not depend on donor age and MELD score. The Andrés score was applied to 102 patients for whom all score variables were available, producing a mean score of 43.4 (SD = 6.6). Survival rates after the date of the first decompensation post-first liver transplantation (LT1) in the liver retransplantation (reLT) group (94 patients decompensated) at 3, 5, and 10 years were 62%, 59%, and 51%, respectively, among 78 retransplanted individuals with advanced cirrhosis, and 42%, 32%, and 16% among 16 retransplanted individuals with FCH. In the non-reLT group with hepatic decompensation, survival rates were 27%, 18%, and 9% at 3, 5, and 10 years, respectively (P < 0.0001). Compared with non-retransplanted patients, retransplanted patients were younger at LT1 (mean age 48 ± 8 years compared to 53 ± 9 years in the no reLT group, P < 0.0001), less likely to have human immunodeficiency virus (HIV) co-infection (4% vs 14% among no reLT patients, P = 0.005), more likely to have received corticosteroid bolus therapy after LT1 (25% in reLT vs 12% in the no reLT group, P = 0.01), and more likely to have presented with sustained virological response (SVR) after the first transplantation (20% in the reLT group vs 7% in the no reLT group, P = 0.028).
  
  
  CONCLUSIONS
  Antiviral therapy before and after retransplantation had a substantial impact on survival in the context of retransplantation for HCV recurrence, and with the new direct-acting antivirals now available, outcomes should be even better in the future.
authors.affiliation: Alice Tung Wan Song, Rodolphe Sobesky, Bruno Roche, Denis Castaing, Jean-Charles Duclos-Vallée, Didier Samuel, INSERM Unit 785, Villejuif 94800, France.
authors.forename: Alice Tung Wan
authors.initials: AT
authors.lastname: Song
authors.affiliation: Alice Tung Wan Song, Rodolphe Sobesky, Bruno Roche, Denis Castaing, Jean-Charles Duclos-Vallée, Didier Samuel, INSERM Unit 785, Villejuif 94800, France.
authors.forename: Rodolphe
authors.initials: R
authors.lastname: Sobesky
authors.affiliation: Alice Tung Wan Song, Rodolphe Sobesky, Bruno Roche, Denis Castaing, Jean-Charles Duclos-Vallée, Didier Samuel, INSERM Unit 785, Villejuif 94800, France.
authors.forename: Carmen
authors.initials: C
authors.lastname: Vinaixa
authors.affiliation: Alice Tung Wan Song, Rodolphe Sobesky, Bruno Roche, Denis Castaing, Jean-Charles Duclos-Vallée, Didier Samuel, INSERM Unit 785, Villejuif 94800, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Dumortier
authors.affiliation: Alice Tung Wan Song, Rodolphe Sobesky, Bruno Roche, Denis Castaing, Jean-Charles Duclos-Vallée, Didier Samuel, INSERM Unit 785, Villejuif 94800, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Radenne
authors.affiliation: Alice Tung Wan Song, Rodolphe Sobesky, Bruno Roche, Denis Castaing, Jean-Charles Duclos-Vallée, Didier Samuel, INSERM Unit 785, Villejuif 94800, France.
authors.forename: François
authors.initials: F
authors.lastname: Durand
authors.affiliation: Alice Tung Wan Song, Rodolphe Sobesky, Bruno Roche, Denis Castaing, Jean-Charles Duclos-Vallée, Didier Samuel, INSERM Unit 785, Villejuif 94800, France.
authors.forename: Yvon
authors.initials: Y
authors.lastname: Calmus
authors.affiliation: Alice Tung Wan Song, Rodolphe Sobesky, Bruno Roche, Denis Castaing, Jean-Charles Duclos-Vallée, Didier Samuel, INSERM Unit 785, Villejuif 94800, France.
authors.forename: Géraldine
authors.initials: G
authors.lastname: Rousseau
authors.affiliation: Alice Tung Wan Song, Rodolphe Sobesky, Bruno Roche, Denis Castaing, Jean-Charles Duclos-Vallée, Didier Samuel, INSERM Unit 785, Villejuif 94800, France.
authors.forename: Marianne
authors.initials: M
authors.lastname: Latournerie
authors.affiliation: Alice Tung Wan Song, Rodolphe Sobesky, Bruno Roche, Denis Castaing, Jean-Charles Duclos-Vallée, Didier Samuel, INSERM Unit 785, Villejuif 94800, France.
authors.forename: Cyrille
authors.initials: C
authors.lastname: Feray
authors.affiliation: Alice Tung Wan Song, Rodolphe Sobesky, Bruno Roche, Denis Castaing, Jean-Charles Duclos-Vallée, Didier Samuel, INSERM Unit 785, Villejuif 94800, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Delvart
authors.affiliation: Alice Tung Wan Song, Rodolphe Sobesky, Bruno Roche, Denis Castaing, Jean-Charles Duclos-Vallée, Didier Samuel, INSERM Unit 785, Villejuif 94800, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Roche
authors.affiliation: Alice Tung Wan Song, Rodolphe Sobesky, Bruno Roche, Denis Castaing, Jean-Charles Duclos-Vallée, Didier Samuel, INSERM Unit 785, Villejuif 94800, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Haim-Boukobza
authors.affiliation: Alice Tung Wan Song, Rodolphe Sobesky, Bruno Roche, Denis Castaing, Jean-Charles Duclos-Vallée, Didier Samuel, INSERM Unit 785, Villejuif 94800, France.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Roque-Afonso
authors.affiliation: Alice Tung Wan Song, Rodolphe Sobesky, Bruno Roche, Denis Castaing, Jean-Charles Duclos-Vallée, Didier Samuel, INSERM Unit 785, Villejuif 94800, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Castaing
authors.affiliation: Alice Tung Wan Song, Rodolphe Sobesky, Bruno Roche, Denis Castaing, Jean-Charles Duclos-Vallée, Didier Samuel, INSERM Unit 785, Villejuif 94800, France.
authors.forename: Edson
authors.initials: E
authors.lastname: Abdala
authors.affiliation: Alice Tung Wan Song, Rodolphe Sobesky, Bruno Roche, Denis Castaing, Jean-Charles Duclos-Vallée, Didier Samuel, INSERM Unit 785, Villejuif 94800, France.
authors.forename: Luiz Augusto Carneiro
authors.initials: LA
authors.lastname: D'Albuquerque
authors.affiliation: Alice Tung Wan Song, Rodolphe Sobesky, Bruno Roche, Denis Castaing, Jean-Charles Duclos-Vallée, Didier Samuel, INSERM Unit 785, Villejuif 94800, France.
authors.forename: Jean-Charles
authors.initials: JC
authors.lastname: Duclos-Vallée
authors.affiliation: Alice Tung Wan Song, Rodolphe Sobesky, Bruno Roche, Denis Castaing, Jean-Charles Duclos-Vallée, Didier Samuel, INSERM Unit 785, Villejuif 94800, France.
authors.forename: Marina
authors.initials: M
authors.lastname: Berenguer
authors.affiliation: Alice Tung Wan Song, Rodolphe Sobesky, Bruno Roche, Denis Castaing, Jean-Charles Duclos-Vallée, Didier Samuel, INSERM Unit 785, Villejuif 94800, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Samuel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D003661:Decision Support Techniques; D005260:Female; D005602:France; D016174:Hepacivirus / Q000472:pathogenicity*; D006526:Hepatitis C / Q000175:diagnosis / Q000401:mortality / Q000601:surgery* / Q000821:virology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery* / Q000821:virology; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome; D014775:Virus Activation; D055815:Young Adult
chemical_list: D000998:Antiviral Agents
keywords: Antivirals; Hepatitis C; Mortality; Prognosis; Retransplantation; Risk factors