Recurrent hepatitis C posttransplant: Early preservation injury may predict poor outcome

Kymberly D S Watt, Elizabeth R. Lyden, James M. Gulizia, Timothy M McCashland

Research output: Contribution to journalArticle

68 Citations (Scopus)

Abstract

Organ cold/warm ischemia is thought to be a risk factor for increased severity of recurrence of hepatitis C (HCV) post liver transplantation. We had noted some HCV patients with preservation injury (PI) to have particularly poor outcomes. Our goal was to determine if PI on biopsy in HCV patients is associated with earlier, more rapidly progressive recurrence or graft and patient survival. Sixty-nine patients from the University of Nebraska transplant database were included: 23 HCV patients with PI (group = 1), 23 non-HCV patients with PI (group = 2), and 23 HCV patients without PI (group = 3). Patient groups were matched for gender, age, immunosuppression, and time of transplantation for analysis. No difference in time to recurrence was noted between HCV groups (256 vs. 316 days posttransplant). More patients in group 1 had progression to stage 3 or 4 fibrosis, compared to group 3 (43 vs. 9%, P = 0.02). One-year survival for groups 1, 2, and 3 was 78, 82, and 100% respectively, whereas 3-yr survival was 59, 82, and 88% (group 1 vs. group 2 or 3 respectively, P = 0.0055). There was no difference in survival between groups 2 and 3. Patients in group 1 that received antiviral treatment had improved survival, compared to those who did not (P = 0.012). Risk factors for poor survival on univariate analysis included severity of PI (Relative Risk = 2.78, P < 0.001) and donor age of >55 (P = 0.014). Multivariate analysis shows HCV is the most important factor. In conclusion, HCV transplant patients with evidence of early PI on biopsy have poorer survival outcomes than non-HCV transplant patients with PI or HCV transplant patients without PI. Consideration for antiviral therapy early in the posttransplant course may be warranted in this subset of patients.

Original languageEnglish (US)
Pages (from-to)134-139
Number of pages6
JournalLiver Transplantation
Volume12
Issue number1
DOIs
StatePublished - Jan 1 2006

Fingerprint

Hepatitis C
Wounds and Injuries
Survival
Transplants
Recurrence
Antiviral Agents
Biopsy
Cold Ischemia
Warm Ischemia
Graft Survival
Liver Transplantation
Immunosuppression
Fibrosis
Research Design
Multivariate Analysis
Transplantation

ASJC Scopus subject areas

  • Surgery
  • Hepatology
  • Transplantation

Cite this

Recurrent hepatitis C posttransplant : Early preservation injury may predict poor outcome. / Watt, Kymberly D S; Lyden, Elizabeth R.; Gulizia, James M.; McCashland, Timothy M.

In: Liver Transplantation, Vol. 12, No. 1, 01.01.2006, p. 134-139.

Research output: Contribution to journalArticle

Watt, Kymberly D S ; Lyden, Elizabeth R. ; Gulizia, James M. ; McCashland, Timothy M. / Recurrent hepatitis C posttransplant : Early preservation injury may predict poor outcome. In: Liver Transplantation. 2006 ; Vol. 12, No. 1. pp. 134-139.
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abstract = "Organ cold/warm ischemia is thought to be a risk factor for increased severity of recurrence of hepatitis C (HCV) post liver transplantation. We had noted some HCV patients with preservation injury (PI) to have particularly poor outcomes. Our goal was to determine if PI on biopsy in HCV patients is associated with earlier, more rapidly progressive recurrence or graft and patient survival. Sixty-nine patients from the University of Nebraska transplant database were included: 23 HCV patients with PI (group = 1), 23 non-HCV patients with PI (group = 2), and 23 HCV patients without PI (group = 3). Patient groups were matched for gender, age, immunosuppression, and time of transplantation for analysis. No difference in time to recurrence was noted between HCV groups (256 vs. 316 days posttransplant). More patients in group 1 had progression to stage 3 or 4 fibrosis, compared to group 3 (43 vs. 9{\%}, P = 0.02). One-year survival for groups 1, 2, and 3 was 78, 82, and 100{\%} respectively, whereas 3-yr survival was 59, 82, and 88{\%} (group 1 vs. group 2 or 3 respectively, P = 0.0055). There was no difference in survival between groups 2 and 3. Patients in group 1 that received antiviral treatment had improved survival, compared to those who did not (P = 0.012). Risk factors for poor survival on univariate analysis included severity of PI (Relative Risk = 2.78, P < 0.001) and donor age of >55 (P = 0.014). Multivariate analysis shows HCV is the most important factor. In conclusion, HCV transplant patients with evidence of early PI on biopsy have poorer survival outcomes than non-HCV transplant patients with PI or HCV transplant patients without PI. Consideration for antiviral therapy early in the posttransplant course may be warranted in this subset of patients.",
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