Reuters Health Information (2005-08-26): Hepatic iron overload reduces survival after liver transplant
Hepatic iron overload reduces survival after liver transplant
Last Updated: 2005-08-26 14:24:20 -0400 (Reuters Health)
NEW YORK (Reuters Health) - In patients who have
undergone liver transplantation, hereditary hemochromatosis associated
with HFE gene mutations or other causes of hepatic iron overload are
associated with reduced survival, investigators in the US report.
Previous studies linking hepatic iron overload with poor outcome
after liver transplantation were conducted before HFE gene testing was
available, Dr. Kris V. Kowdley and his colleagues note in their report
in the August issue of the journal Gastroenterology.
Dr. Kowdley, from the University of Washington in Seattle, and his
team therefore performed HFE genotyping on preserved specimens of 260
patients who underwent liver transplantation prior to 1996 at one of 12
liver transplantation centers. All the patients had been diagnosed with
hemochromatosis or hepatic iron overload.
HFE-associated hemochromatosis was defined as homozygosity for the
C282Y mutation (n = 14) or compound heterozygosity for the C282Y/H63D
mutation (n = 11). One- and 5-year posttransplantation survival was 64%
and 34% in this group.
In contrast, among patients with other HFE mutations (C282Y or H63D
heterozygotes or H63D homozygotes) or who were wildtype, the 1- and
3-year survival was 80% and 64%. The adjusted hazard ratio for death
comparing HH with non-HH patients in this cohort was 2.6.
Compared with the general population of liver transplant patients at
those institutions prior to 1996 (n = 5493), those without
HFE-associated hemochromatosis but with iron overload still had reduced
survival (5-year survival 63% versus 72%).
Thus, the authors comment, "hepatic iron overload may diminish
survival postliver transplantation even among patients without
HFE-associated hemochromatosis when compared with patients without
hepatic iron overload."
They add: "We believe our findings warrant additional research to
improve methods for identification of hepatic iron overload prior to
liver transplantation, to characterize better the causes of increased
mortality in patients with HFE-associated hemochromatosis and to
examine the feasibility and efficacy of iron depletion prior to liver
transplantation in patients with hepatic iron overload."