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Retransplantation for hepatitis C: results of a U.S. multicenter retransplant study
Timothy McCashland1, Kymberly Watt, Elizabeth Lyden
1Department of Hepatology, University of Nebraska Medical Center, Omaha, NE 68198-3285, USA. tmccashland@unmc.edu
Insights
Liver retransplantation for recurrent hepatitis C virus (HCV) infection shows similar survival rates to retransplantation for other causes. Many HCV patients are not listed for retransplantation, despite comparable outcomes.
Area of Science:
- Hepatology and Transplant Surgery
- Viral Hepatitis Research
- Clinical Outcomes Analysis
Background:
- Retransplantation (reTX) for recurrent hepatitis C virus (HCV) infection is debated due to perceived poor outcomes.
- Limited data exists comparing reTX for HCV versus other indications.
Purpose of the Study:
- To retrospectively compare survival rates after liver retransplantation in patients with recurrent HCV versus those transplanted for other indications.
Main Methods:
- A U.S. study group analyzed data from 1996-2004.
- Patients were divided into three groups: HCV reTX (n=43), non-HCV reTX (n=73), and recurrent HCV without reTX (n=156).
- Survival rates, hospitalization duration, ICU days, and Model for End-Stage Liver Disease (MELD) scores were compared.
Main Results:
- One-year and 3-year survival rates after reTX were similar for HCV reTX (69% vs. 49%) and non-HCV reTX (73% vs. 55%) groups.
- MELD scores were not predictive of reTX survival, although survival was <50% in non-HCV patients with MELD >30.
- Among patients with recurrent HCV not undergoing reTX, only 15% were listed, with a 3-year survival of 47%; common reasons for non-listing included recurrent HCV and renal dysfunction.
Conclusions:
- Liver retransplantation for recurrent HCV yields comparable survival rates to retransplantation for other indications.
- Many patients with recurrent HCV are not considered for retransplantation, potentially due to disease recurrence or other complications.
- Further investigation into listing criteria for HCV retransplantation is warranted.
Abstract:
It is widely perceived that outcomes are relatively poor following retransplantation (reTX) for recurrent of hepatitis C virus (HCV) infection. Transplant centers debate the utility of offering another liver to these patients. A U.S. study group was formed to retrospectively compare survival after reTX in patients with recurrent HCV (histologically proven) and those transplanted for other indications greater than 90 days after first transplantation, from 1996 to 2004. Patients were divided into 3 groups; group 1: HCV reTX (n = 43), group 2: non-HCV reTX (n = 73), and group 3: recurrent HCV but no reTX (n = 156). They were predominantly male, Caucasian, with mean age of 47.2 yr. The commonest indications for non-HCV reTX were chronic rejection (36%), hepatic artery thrombosis (31%) and recurrent primary sclerosing cholangitis (17%). Duration of hospitalization, number of intensive care unit (ICU) days, and time interval from listing to transplantation or reTX were similar between reTX groups. The 1-yr and 3-yr survival rates after reTX were also similar for HCV reTX and non-HCV reTX groups (1 yr, 69% vs. 73%; 3 yr, 49% vs. 55%). Model for End-Stage Liver Disease (MELD) scores were not predictive of survival from reTX. However, with a MELD score of >30 in the non HCV group, survival was <50%. In the recurrent HCV not undergoing reTX group, 30% were reevaluated for reTX but only 15% were listed for reTX and the 3-yr survival was 47%. The most common reasons for not listing for reTX were recurrent HCV within 6 months (22%), fibrosing cholestatic hepatitis (19%), and renal dysfunction (9%). In conclusion, patients retransplanted for recurrent HCV had similar 1-yr and 3-yr survival when compared to patients undergoing reTX for other indications. MELD scores were not predictive of post-reTX survival. Survival was <50% in the non-HCV reTx group with MELD score of >30. Many patients with recurrent HCV are not considered for reTX and die from recurrent disease.
