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PREDICTING OUTCOME IN PATIENTS WITH HCV AFTER OLT: A 15-YEARS FOLLOW-UP
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Ulf P. Neumann, Marcus Bahra, Charite´, Virchow Clinic, Dept. of Surgery, Berlin, Germany; Max Schmeding, Charite´, Virchow Clinic, Dept of Surgery, Berlin, Germany; Jan M. Langrehr, Charite´, Virchow Clinic, Dept. of Surgery, Berlin, Germany; Thomas Berg, Charite´, Virchow Clinic, Dept. of Hepatology, Berlin; Peter Neuhaus, Charite´, Virchow Clinic, Dept. of Surgery, Berlin, Germany
End-stage hepatitis-C-virus (HCV) infection is a frequent indication for orthotopic liver transplantation (OLT). Recurrence of HCV infection after OLT is almost universal, however, graft hepatitis is often mild. Severity of graft hepatitis increases during the long term follow-up and approximately 10 % of patients develop severe graft hepatitis and cirrhosis after liver transplantation due to
HCV-related liver cirrhosis. The aim of this study was to first examine the histological course in the long-term after OLT and to analyze early predictors for graft failure due to HCV recurrence.
In a retrospective analysis 301 OLT‘s in 268 HCV positive patients were reviewed for outcome after OLT. Median age of the patients was 53 years. Immunosuppression was commenced as a CsA-based quadruple induction therapy including ATG or an IL2- receptor antagonist or with Tacrolimus. Routine liver biopsies were performed 1-, 3-, 5-, 7-, 10-, 12- and 15-years after OLT.
Actuarial 5-, 10- and 15-year patient survival figures were 73%, 64% and 56%, respectively. 38/301 (12,6%) of the transplants developed a graft failure due to HCV recurrence. Mean fibrosis stage was 1.3, 1.8, 2.0, 2.2, 2.2 and 2,5 after 1-, 3-, 5-, 7-, 10- and 12-years. Roc analysis identified donor age above 32 years to be significantly associated to rapid fibrosis progression, graft loss due to
recurrent hepatitis C and overall survival (p<0.001).
Additionally, 2-fold increased ASAT/ALAT levels 4-weeks after transplantation
correlated to fibrosis progression, severe recurrent hepatitis C and overall survival. Combining these factors, recipients with a graft above 32 years and 2-fold increased transaminasis at day 28 after OLT, had a 19-times increased risk for HCV related graft loss.
This first analysis of routinely performed liver biopsies in patients with HCV more than 10 years after OLT clearly shows that despite slower fibrosis progression in the long-term and good patient survival figures HCV-recurrence will emerge as one of the main problems in liver transplantation in the future. Nearly 50% of the
patients surviving more than 5 years after OLT showed again signs of liver fibrosis and cirrhosis. However, progress of HCV recurrence can be predicted early after OLT when analyzing transaminasis at day 28. The effect of virus genotype and quantitative HCV-RNA is still under investigation.
This analysis allows to early identify high risk patients for severe recurrent hepatitis C and may help to select early appropriate antiviral treatment protocols
as well as adapted immunosuppressive protocols in this patient population.
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