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Hepatitis C: indication for anti-viral therapy?
K P Platz1, A R Mueller, R Neuhaus
1Department of Surgery, Virchow Clinic, Humboldt University Berlin, Germany.
Insights
Liver transplantation for Hepatitis C virus (HCV) shows similar survival rates to other indications. However, recurrent HCV graft hepatitis and chronic rejection pose significant challenges, necessitating targeted antiviral therapies.
Area of Science:
- Hepatology
- Transplantation Immunology
- Virology
Background:
- Hepatitis C virus (HCV) infection is a common reason for liver transplantation.
- Recurrent hepatitis post-transplant is often mild but can lead to severe complications.
Purpose of the Study:
- To evaluate patient and graft survival after liver transplantation in HCV patients compared to other indications.
- To analyze the incidence and impact of recurrent hepatitis, rejection, and retransplantation in HCV recipients.
Main Methods:
- Retrospective analysis of 500 liver transplants (123 for HCV) between 1988-1994.
- Comparison of survival rates, retransplantation incidence, and rejection episodes between HCV and non-HCV groups.
- Histological confirmation of recurrent graft hepatitis.
Main Results:
- 1- to 6-year patient survival was comparable: 87.0% for HCV vs. 86.0% for others.
- HCV recurrence and chronic rejection caused 50% of deaths in HCV patients.
- Steroid-resistant rejection was significantly higher in HCV patients (29.3%) vs. others (14.5%).
- Recurrent graft hepatitis was diagnosed in 45 of 123 HCV patients.
- A significant association was found between acute rejection and recurrent graft hepatitis.
Conclusions:
- Liver transplantation for HCV offers comparable survival rates to other indications.
- Recurrent graft hepatitis combined with chronic rejection is a major limiting factor for HCV patients.
- The findings underscore the need for effective antiviral strategies in liver transplant recipients with HCV.
Abstract:
Hepatitis C infection is a frequent indication for liver transplantation. In general, recurrent graft hepatitis is assumed to be mild, but may be the cause of lethal postoperative complications in a small patient population. Out of 500 transplants in 458 patients, 123 patients were transplanted due to hepatitis C infection (26.7%) between September 1988 and April 1994. Cumulative 1- to 6-year patient survival was similar for patients transplanted due to hepatitis C (87.0%) and those transplanted for other indications (86.0%). In patients with hepatitis C virus (HCV), death, in 50% of the cases, was related to HCV recurrence and chronic rejection. Four patients (25.0%) died because of severe infection and multiple organ failure syndrome unrelated to HCV recurrence and chronic rejection. The incidence of retransplantation was similar in HCV (9.8%) and other patients (8.4%). In HCV patients, 6 of 12 retransplantations (50.0%) were performed due to HCV recurrence and chronic rejection. Of 123 HCV patients, 45 experienced histologically proven recurrent graft hepatitis between 2 weeks and 5.5 years after transplantation. The incidence of acute rejection was similar in both groups. The incidence of steroid-resistant rejection was, however, higher in HCV patients (29.3%) than in those transplanted for other indications (14.5%; P < or = 0.05). Furthermore, there was a significant association between acute rejection and the development of recurrent graft hepatitis. In conclusion, patients with hepatitis C may be transplanted with as good patient and graft survival rates as patients transplanted for other indications. However, the combination of recurrent graft hepatitis and chronic rejection remains the most limiting factor for some of these patients, which strengthens the necessity for a specific anti-viral therapy.