Retransplantation for hepatitis C: Results of a U.S. multicenter retransplant study

Timothy M McCashland, Kymberly Watt, Elizabeth Lyden, Leon Adams, Michael Charlton, Alastair D. Smith, Brendan M. McGuire, Scott W. Biggins, Guy Neff, James R. Burton, Hugo Vargas, John Donovan, James Trotter, Thomas Faust

Research output: Contribution to journalArticle

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Abstract

It is widely perceived that outcomes are relatively poor following retransplantation (reTX) for recurrent of hepatitis C virus (HCV) infection. Transplant centers debate the utility of offering another liver to these patients. A U.S. study group was formed to retrospectively compare survival after reTX in patients with recurrent HCV (histologically proven) and those transplanted for other indications greater than 90 days after first transplantation, from 1996 to 2004. Patients were divided into 3 groups; group 1: HCV reTX (n = 43), group 2: non-HCV reTX (n = 73), and group 3: recurrent HCV but no reTX (n = 156). They were predominantly male, Caucasian, with mean age of 47.2 yr. The commonest indications for non-HCV reTX were chronic rejection (36%), hepatic artery thrombosis (31%) and recurrent primary sclerosing cholangitis (17%). Duration of hospitalization, number of intensive care unit (ICU) days, and time interval from listing to transplantation or reTX were similar between reTX groups. The 1-yr and 3-yr survival rates after reTX were also similar for HCV reTX and non-HCV reTX groups (1 yr, 69% vs. 73%; 3 yr, 49% vs. 55%). Model for End-Stage Liver Disease (MELD) scores were not predictive of survival from reTX. However, with a MELD score of >30 in the non HCV group, survival was <50%. In the recurrent HCV not undergoing reTX group, 30% were reevaluated for reTX but only 15% were listed for reTX and the 3-yr survival was 47%. The most common reasons for not listing for reTX were recurrent HCV within 6 months (22%), fibrosing cholestatic hepatitis (19%), and renal dysfunction (9%). In conclusion, patients retransplanted for recurrent HCV had similar 1-yr and 3-yr survival when compared to patients undergoing reTX for other indications. MELD scores were not predictive of post-reTX survival. Survival was <50% in the non-HCV reTx group with MELD score of >30. Many patients with recurrent HCV are not considered for reTX and die from recurrent disease.

Original languageEnglish (US)
Pages (from-to)1246-1253
Number of pages8
JournalLiver Transplantation
Volume13
Issue number9
DOIs
StatePublished - Sep 1 2007

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Hepatitis C
Hepacivirus
Multicenter Studies
End Stage Liver Disease
Viruses
Survival
Transplantation
Sclerosing Cholangitis
Hepatic Artery
Virus Diseases
Intensive Care Units
Hospitalization
Thrombosis
Survival Rate
Transplants
Liver

ASJC Scopus subject areas

  • Surgery
  • Hepatology
  • Transplantation

Cite this

McCashland, T. M., Watt, K., Lyden, E., Adams, L., Charlton, M., Smith, A. D., ... Faust, T. (2007). Retransplantation for hepatitis C: Results of a U.S. multicenter retransplant study. Liver Transplantation, 13(9), 1246-1253. https://doi.org/10.1002/lt.21322

Retransplantation for hepatitis C : Results of a U.S. multicenter retransplant study. / McCashland, Timothy M; Watt, Kymberly; Lyden, Elizabeth; Adams, Leon; Charlton, Michael; Smith, Alastair D.; McGuire, Brendan M.; Biggins, Scott W.; Neff, Guy; Burton, James R.; Vargas, Hugo; Donovan, John; Trotter, James; Faust, Thomas.

In: Liver Transplantation, Vol. 13, No. 9, 01.09.2007, p. 1246-1253.

Research output: Contribution to journalArticle

McCashland, TM, Watt, K, Lyden, E, Adams, L, Charlton, M, Smith, AD, McGuire, BM, Biggins, SW, Neff, G, Burton, JR, Vargas, H, Donovan, J, Trotter, J & Faust, T 2007, 'Retransplantation for hepatitis C: Results of a U.S. multicenter retransplant study', Liver Transplantation, vol. 13, no. 9, pp. 1246-1253. https://doi.org/10.1002/lt.21322
McCashland, Timothy M ; Watt, Kymberly ; Lyden, Elizabeth ; Adams, Leon ; Charlton, Michael ; Smith, Alastair D. ; McGuire, Brendan M. ; Biggins, Scott W. ; Neff, Guy ; Burton, James R. ; Vargas, Hugo ; Donovan, John ; Trotter, James ; Faust, Thomas. / Retransplantation for hepatitis C : Results of a U.S. multicenter retransplant study. In: Liver Transplantation. 2007 ; Vol. 13, No. 9. pp. 1246-1253.
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