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Published on: November 7, 2020
The association between hepatitis C infection and survival after orthotopic liver transplantation
Lisa M Forman1, James D Lewis, Jesse A Berlin
1Center for Clinical Epidemiology and Biostatistics and the Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. formanl@mail.med.upenn.edu
Insights
Hepatitis C viral (HCV) infection negatively impacts patient and allograft survival after liver transplantation. This study found increased mortality and graft failure in HCV-positive recipients, especially women.
Area of Science:
- Hepatology
- Transplantation Immunology
- Viral Hepatitis
Background:
- The impact of hepatitis C viral (HCV) infection on outcomes after orthotopic liver transplantation remains debated.
- HCV recurrence is common post-transplant, yet prior studies showed no survival difference.
Purpose of the Study:
- To investigate the effect of HCV infection on patient and allograft survival post-liver transplantation.
- To clarify the controversial findings regarding HCV and transplant outcomes.
Main Methods:
- Retrospective cohort study of 11,036 patients undergoing 11,791 liver transplants (1992-1998).
- Utilized United Network for Organ Sharing data.
- Assessed survival using proportional-hazards analysis, adjusting for confounders.
Main Results:
- HCV-positive recipients had significantly higher rates of death (HR 1.23) and allograft failure (HR 1.30) compared to HCV-negative recipients.
- Survival disadvantage persisted after adjustment for confounding variables.
- A significant interaction between HCV and sex was observed, with the greatest negative impact on survival in female recipients.
Conclusions:
- HCV infection is a significant independent risk factor for reduced patient and allograft survival following liver transplantation.
- HCV poses a substantial threat to long-term success in liver transplant recipients.
Background & Aims:
The effect of hepatitis C viral (HCV) infection on patient and allograft survival after orthotopic liver transplantation is controversial. Hepatitis C recurrence after transplant is inevitable, but studies to date have not found a survival difference between recipients with and without HCV.
Methods:
Using data from the United Network for Organ Sharing, we performed a retrospective cohort study of 11,036 patients who underwent 11,791 liver transplants between 1992 and 1998. The hazard rates of patient and allograft survival for patients who were HCV-positive as compared with patients who were HCV-negative were assessed by proportional-hazards analysis, with adjustment for potential confounding variables, including donor, recipient, and transplant center characteristics.
Results:
Liver transplantation in HCV-positive recipients was associated with an increased rate of death (hazard ratio, 1.23; 95% confidence interval [CI], 1.12-1.35) and allograft failure (hazard ratio, 1.30; 95% CI, 1.21-1.39), as compared with transplantation in HCV-negative recipients. This reduction in survival persisted after adjusting for potential confounders. There was an interaction between HCV and sex (P < 0.001) with the effect of HCV on survival being most pronounced in female recipients (patient survival hazard ratio, 1.56; 95% CI, 1.35-1.81; allograft survival hazard ratio, 1.51; 95% CI, 1.34-1.70).
Conclusions:
HCV infection significantly impairs patient and allograft survival after liver transplantation.
