Clinical

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."

Gastroenterology 2005;129:494-503.