Clinical

Hemochromatosis no barrier to successful liver transplantation

Last Updated: 2007-09-07 20:03:28 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Over the last decade, patients with hemochromatosis did as well or better after liver transplantation than those without the iron overload disease, two physicians-researchers report in the August issue of Gastroenterology.

Historically, patients with hemochromatosis did not fare well after undergoing liver transplantation, Dr. Lei Yu and Dr. George N. Ioannou explain. They speculated that advances in patient care and better patient selection may have improved their outlook.

To explore these issues, Dr. Yu and Dr. Ioannou, at the University of Washington in Seattle, obtained records from the United Network for Organ Sharing for liver transplantations performed in the US. They compared outcomes among patients with hemochromatosis who received a liver transplant between 1990 and 1996 versus those who underwent transplantation between 1997 and 2006.

Included were 177 (1.1%) patients with hemochromatosis before 1997 and 217 (0.06%) afterward. Patients without hemochromatosis totaled 16,109 and 33,803, respectively.

During the initial study period, post-transplant survival was worse than that of patients without hemochromatosis. The 5-year survival was 64.6% among those with hemochromatosis and 73.8% for the rest of the patients.

"Recipients with hemochromatosis had the worst post-transplantation survival of any other recipient group defined by cause of liver disease other than hepatocellular carcinoma," the results show.

During the recent period, outcomes were "excellent" for patients with hemochromatosis, Drs. Yu and Ioannou report. Five-year survival was 77.3% for patients with hemochromatosis versus 74.0% for those with other indications for the procedure.

In fact, the survival among hemochromatosis patients was "superior to not only recipients with hepatocellular carcinoma but also those with hepatitis C infection, nonalcoholic steatohepatitis or cryptogenic cirrhosis, alcoholic liver disease or acute hepatic failure."

The authors suggest that more stringent exclusion of patients with cardiac disease and improved patient care may have affected outcomes after receiving a liver transplant.

Gastroenterology 2007;133:489-495.