Outcome of orthotopic liver transplantation in patients with hepatitis C
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Published on: December 1, 2023
Seung W Paik1, Henkie P Tan, Andrew S Klein
1Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA.
Insights
Hepatitis C (HCV) recurrence after liver transplant (OLT) is common. While short-term outcomes are good, long-term survival for HCV patients shows a trend towards being lower than for primary biliary cirrhosis or primary sclerosing cholangitis patients.
Area of Science:
- Hepatology
- Transplantation Immunology
- Virology
Background:
- Hepatitis C virus (HCV) recurrence post-orthotopic liver transplantation (OLT) is a universal challenge.
- Long-term prognosis for HCV patients after OLT remains incompletely understood despite favorable short-term outcomes.
Purpose of the Study:
- To evaluate the long-term outcomes of patients with HCV undergoing OLT.
- To identify risk factors associated with poor outcomes in this patient population.
Main Methods:
- Retrospective analysis of 58 OLT patients with HCV transplanted between 1990 and 1997.
- Comparison of patient and graft survival with 42 primary biliary cirrhosis (PBC) and 41 primary sclerosing cholangitis (PSC) patients.
- Assessment of HCV recurrence using biochemical, histological, and virological markers.
Main Results:
- Biochemical evidence of recurrent HCV hepatitis was absent in 46% of patients; 40% had recurrent hepatitis, and 14% showed clinical signs.
- Patient survival rates at one, three, and five years were 94.8%, 84.1%, and 62.2%, respectively.
- No statistically significant difference in survival was observed between HCV patients and PBC/PSC cohorts, though a trend towards lower five-year survival in HCV patients was noted.
Conclusions:
- While not statistically significant, a trend suggests lower five-year survival for HCV patients post-OLT compared to PBC and PSC cohorts.
- The type of immunosuppression (cyclosporine vs. tacrolimus) did not correlate with HCV recurrence rates.
- Liver disease progression, including cirrhosis development, occurred over time in a subset of HCV patients post-transplant.
Abstract:
Recurrence of chronic hepatitis C (HCV) after orthotopic liver transplantation (OLT) is universal. The published studies suggest that the short-term outcome is good in these patients, but the long-term prognosis remains unclear. The purpose of this study was to evaluate the outcome of patients with HCV undergoing OLT in a single center and to analyze the risk factors associated with poor outcome. In this retrospective study, we evaluated the outcome of 58 OLT patients with proven HCV who underwent OLT between February 1990 and April 1997 at our institution. The median follow-up time was 36.9 months. Recurrent posttransplant HCV hepatitis was confirmed by liver biochemistry, histology, and persistent HCV RNA in the serum. The patient and graft survival of patients with HCV was compared to that of 42 primary biliary cirrhosis (PBC) and 41 primary sclerosing cholangitis (PSC) patients transplanted during the same period. Following OLT, biochemical evidence of recurrent HCV hepatitis was absent in 46%. Forty percent of patients had recurrent HCV hepatitis and 14% had clinical evidence of recurrent HCV. Thirty-one patients were on cyclosporine, 22 patients on tacrolimus, and 5 patients had cyclosporine switched to tacrolimus or vice versa. The recurrence rate of HCV chronic hepatitis was similar in patients who had cyclosporine (35.5%) or tacrolimus (45.5%) based immunosuppression. Eleven patients (19%) died and five patients (8.6%) were retransplanted for chronic rejection (two), mismatch (one), or primary graft nonfunction (two). The cumulative patient survival rates of one, three, and five years were 94.8%, 84.1%, and 62.2%, respectively. The severity of liver disease progressed with time; 8% of patients developed cirrhosis within two years. The survival rate did not show any relation between HCV recurrence and the type of immunosuppression. In conclusion, although the survival of patients with HCV was not statistically significant compared to those with PBC or PSC, there was a trend towards a lower five-year survival in HCV.
