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RECURRENT HEPATITIS C IS A RISK FACTOR FOR POOR OUTCOME AFTER LIVER RETRANSPLANTATION
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The leading cause of death in all hepatitis C retransplanted patients was severe recurrent HCV leading to liver failure.
Reported by Jules Levin
AASLD
San Francisco, Nov 11, 2005
Jordana L. Soule, Oregon Health and Science University and Portland VA Medical Center, Portland, OR; Ali Olyaei, Oregon Health Science and University and Portland VA Medical Center, Portland, OR; Jonathan M. Schwartz, Hugo R. Rosen, John M. Ham, Susan L. Orloff, Oregon Health and Science University and Portland VA Medical Center, Portland, OR
Background: Liver retransplantation is the only known treatment for patients with a failed first graft. Organ shortage and allocation mandate optimal patient selection for retransplantation. Retransplantation results, known to be inferior to those of primary transplantation, highlight the importance of strict selection criteria. Improved stratification of retransplantation candidates would enhance
outcomes and optimize use of available organs.
Aim: To determine the factors which affect outcome and survival of patients undergoing liver retransplantation, and to evaluate the effect of recurrent HCV on retransplantation outcomes.
Methods: 712 consecutive adult liver transplants performed at a single center (tertiary care university and Veterans Affairs teaching hospital) from May 1989 to February 2004 were retrospectively reviewed. Indication for, and time to re-transplantation, survival, and cause of death after retransplantation were assessed. Patient follow-up was 1 to 14 years. Statistical analysis was performed
using Chi-square and Kaplan Meier test.
Results: From May 1989 to February 2004, 669 patients underwent primary liver transplantation and 42 patients underwent a first retransplantation (6.3%)(13 female, 29 male; mean age 44.6 years range from 22 to 67). Median time to retransplantation was 215 days.
One-year, 5-year, and 10-year actuarial patient survival rates following retransplantation were significantly less than for patients undergoing
primary transplantation (65%, 48%, and 40% vs. 85%, 73%, and 49% respectively, p 0.01). Median time from retransplantation to death was 178 days.
The indications for retransplantation were Hepatitis C recurrence (n 13, 31%), primary non-function (n 9, 21%), acute or chronic rejection (n 5, 12%), hepatic artery thrombosis (n=5, 12%), intrahepatic biliary strictures (n=2, 5%), PSC recurrence (n=3, 7%) and veno-occlusive disease or other (n=5, 12%). Those
patients retransplanted for recurrent Hepatitis C had a significantly worse survival outcome at 5 years compared with those retransplanted for all other indications (60% vs. 28%, p 0.03). The leading cause of death in all hepatitis C retransplanted patients was severe recurrent HCV leading to liver failure.
Conclusion: Despite improvements in immunosuppression, surgical techniques, and critical care, the overall outcomes for liver retransplantation are inferior to those for primary transplantation for HCV. The shortage of donor organs, and the goal of optimization of resources, mandates application of a more restricted selection criteria when listing patients with recurrent Hepatitis C for retransplantation.
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