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Hepatitis C viral infection in liver transplantation
M W Johnson1, W K Washburn, R B Freeman
1Transplantation Unit, Massachusetts General Hospital, Boston, USA.
Insights
Liver transplantation for chronic active hepatitis C virus (HCV) offers favorable survival, despite high recurrence rates. Retransplantation for recurrent HCV infection has poor outcomes, warranting careful consideration. Interferon therapy may benefit patients with recurrent hepatitis C.
Area of Science:
- Hepatology
- Transplant Surgery
- Virology
Background:
- Chronic active hepatitis C virus (HCV) infection is a leading cause of end-stage liver disease.
- Liver transplantation is a definitive treatment option for eligible patients with HCV-related liver failure.
- Understanding post-transplant outcomes is crucial for patient management and resource allocation.
Purpose of the Study:
- To evaluate the outcomes of liver transplantation in patients with chronic active hepatitis C virus (HCV).
- To assess survival rates, recurrence of HCV infection, and development of post-transplant complications.
- To determine the efficacy of interferon therapy and the impact of immunosuppression on outcomes.
Main Methods:
- Retrospective review of 74 adult liver transplant recipients with chronic active hepatitis C virus (HCV) between 1990 and 1994.
- Analysis of actuarial survival rates, HCV recurrence, hepatitis, cirrhosis, and retransplantation rates.
- Comparison of outcomes based on recurrent HCV infection and immunosuppressive regimens (tacrolimus).
Main Results:
- Actuarial survival rates were 79.3%, 70.9%, and 64.5% at 1, 2, and 3 years, respectively.
- HCV recurrence was observed in 57% of patients, with 33% of deaths and all retransplantations linked to recurrent HCV.
- A higher incidence of post-transplant cirrhosis was noted with tacrolimus (31.8% vs. 8.9%).
- Interferon alfa therapy showed significant benefit in liver function tests for patients with recurrent HCV.
Conclusions:
- Liver transplantation for chronic active hepatitis C virus (HCV) provides favorable survival despite frequent recurrence.
- Retransplantation for recurrent HCV infection is associated with poor outcomes and should be carefully reconsidered.
- Immunosuppression intensity may influence recurrent HCV infection and cirrhosis development.
- Interferon therapy demonstrates potential benefit in managing post-transplant recurrent HCV hepatitis.
Objective:
To study the outcomes of patients who underwent liver transplantation for the primary diagnosis of chronic active hepatitis secondary to hepatitis C virus (HCV).
Design And Setting:
Retrospective review within a university medical center.
Patients:
Seventy-four adult recipients who received 78 orthotopic liver allografts for the primary diagnosis of chronic active hepatitis secondary to HCV between January 1990 and December 1994. Sixty-seven patients (91%) survived more than 2 months and were analyzed further for recurrent HCV infection.
Main Outcome Measure:
Recurrence of HCV infection, hepatitis, or cirrhosis and survival rates for patients who were undergoing orthotopic liver transplantation for chronic active hepatitis secondary to HCV.
Results:
Actuarial survival rates for the entire group were 79.3%, 70.9%, and 64.5% at 1,2, and 3 years, respectively. Four patients (5% underwent retransplantation with an actuarial survival rate of 14.3% at 1 year (P<.05). Thirty-eight patients (57%) had evidence of posttransplant HCV infection, 31 patients (46%) showed histologic evidence of viral hepatitis, and 11 patients (16%) experienced portal fibrosis or cirrhosis. Seven (33%) of the deaths and all retransplantations were secondary to recurrent HCV infection. There were no significant differences in age, sex, United Network of Organ Sharing status, associated diagnoses, intraoperative packed red blood cell requirements, OKT3 use, or 1-, 2-, and 3-year survival rates in the recurrent vs nonrecurrent HCV infection groups. A higher incidence of posttransplant cirrhosis was observed in patients who were treated with tacrolimus (FK 506) (31.8% vs 8.9%, P<.05). Twenty-one patients (70%) received interferon alfa antiviral therapy with a significant benefit in the liver function test results during therapy (P<.01).
Conclusions:
Despite recurrence of HCV infection in most patients after transplantation, survival following primary orthotopic liver transplantation for chronic active hepatitis secondary to HCV infection remains favorable, and these patients should continue to be candidates for liver transplantation. In contrast, survival following retransplantation for HCV infection is poor and should be reconsidered. There is an apparent association between the intensity of immunosuppression and recurrent HCV infection and cirrhosis that warrants continued evaluation. Interferon therapy appears to afford benefit to patients in whom recurrent HCV hepatitis develops after transplantation.