Clinical

Liver transplant outcomes no worse for HCV-infected recipients

Last Updated: 2004-09-16 16:50:07 -0400 (Reuters Health)

By Megan Rauscher

NEW YORK (Reuters Health) - The first detailed report of 10-year outcomes in liver transplant recipients with hepatitis C virus (HCV) infection shows that these individuals fare just as well in the long run as those undergoing liver transplantation for other indications.

Recurrence of HCV infection, however, is an important cause of mortality and graft loss and the impact of HCV infection increases with time.

HCV infection is "the most common indication for liver transplantation in North America and Western Europe," Dr. Michael Charlton from the Mayo Clinic in Rochester, Minnesota told Reuters Health.

In the September issue of the journal Liver Transplantation, he and colleagues present data for 165 HCV-infected liver transplant recipients who were followed for up to 12 years after transplantation.

"Long-term outcomes, specifically patient and liver graft survival, are as good for patients with [HCV] as they are for patients with almost any other cause of liver disease," Dr. Charlton said. "This is contrary to the findings of less complete and rigorous datasets."

Adjusted 10-year graft survival was 64% for HCV-infected individuals and 51% for uninfected individuals.

"We [also] found that some simple, readily identifiable variables (higher pretransplant HCV RNA, negative CMV IgG serostatus, greater recipient age and greater donor age) were associated with a high likelihood of posttransplant death or graft failure," Dr. Charlton said.

These variables were incorporated in a formula that generated a "risk score." A risk score above a certain level was "strongly predictive of posttransplant death or graft loss," Dr. Charlton reported.

For example, rates of mortality and graft loss at 1 and 5 years posttransplant were 22% and 39%, respectively, among recipients with a high pretransplant HCV score compared with 10% and 22% for recipients with a lower risk score.

"The implications are that patients might be selected to minimize the risk," Dr. Charlton explained. "For example, an older patient might be provided with a recipient from a younger donor or HCV RNA levels might be reduced with antiviral treatment prior to transplantation when safe and practical."

Liver Transpl 2004;10:1120-1130.