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Long-term outcome of liver transplants for chronic hepatitis C: a 10-year follow-up.
Transplantation 2004; 77(2):226-31T

Abstract

BACKGROUND

Recurrence of hepatitis C (HCV) infection after orthotopic liver transplantation (OLT) in HCV-positive patients is almost universal. Severity of graft hepatitis increases during the long-term follow-up, and up to 30% of patients develop severe graft hepatitis and cirrhosis. However, there are still no clear predictors for severe recurrence. The aim of this study was to examine the 10-year outcome and risk factors for graft failure caused by HCV recurrence.

METHODS

In a prospective analysis, 234 OLTs in 209 HCV-positive patients with a median age of 53 years were analyzed. Immunosuppression was based on cyclosporine A or tacrolimus in different protocols. Predictors for outcome were genotype, viremia, donor variables, recipient demographics, postoperative immunosuppression, and human leukocyte antigen (HLA) compatibilities.

RESULTS

Actuarial 5-, and 10-year patient survival was 75.8% and 68.8%. Eighteen of 209 (8.7%) patients died because of HCV recurrence, which was responsible for 35.9% of the total 53 deaths. Significant risk factors for HCV-related graft failure in an univariate analysis were multiple steroid pulses, use of OKT3, and donor age greater than 40. However, in a multivariate analysis, multiple rejection treatments with steroids and OKT3 treatment proved to be significantly associated with HCV-related graft loss.

CONCLUSIONS

The analysis of causes leading to graft failure in patients with HCV showed that HCV recurrence is responsible for one of three deaths in HCV-positive patients. Rejection treatment contributed significantly to an enhanced risk for HCV-related graft loss. New antiviral treatments, as well as adapted immunosuppressive protocols, will be necessary to further improve the outcome of HCV-positive patients after liver transplantation.

Authors+Show Affiliations

Klinik für Allgemein-, Viszeral-, und Transplantationschirurgie, Universitätsklinikum Charité, Campus Virchow-Klinikum, Humboldt-Universität, Berlin, Germany. ulf.neumann@charite.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

14742986

Citation

Neumann, Ulf P., et al. "Long-term Outcome of Liver Transplants for Chronic Hepatitis C: a 10-year Follow-up." Transplantation, vol. 77, no. 2, 2004, pp. 226-31.
Neumann UP, Berg T, Bahra M, et al. Long-term outcome of liver transplants for chronic hepatitis C: a 10-year follow-up. Transplantation. 2004;77(2):226-31.
Neumann, U. P., Berg, T., Bahra, M., Puhl, G., Guckelberger, O., Langrehr, J. M., & Neuhaus, P. (2004). Long-term outcome of liver transplants for chronic hepatitis C: a 10-year follow-up. Transplantation, 77(2), pp. 226-31.
Neumann UP, et al. Long-term Outcome of Liver Transplants for Chronic Hepatitis C: a 10-year Follow-up. Transplantation. 2004 Jan 27;77(2):226-31. PubMed PMID: 14742986.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term outcome of liver transplants for chronic hepatitis C: a 10-year follow-up. AU - Neumann,Ulf P, AU - Berg,Thomas, AU - Bahra,Marcus, AU - Puhl,Gero, AU - Guckelberger,Olaf, AU - Langrehr,Jan M, AU - Neuhaus,Peter, PY - 2004/1/27/pubmed PY - 2004/2/28/medline PY - 2004/1/27/entrez SP - 226 EP - 31 JF - Transplantation JO - Transplantation VL - 77 IS - 2 N2 - BACKGROUND: Recurrence of hepatitis C (HCV) infection after orthotopic liver transplantation (OLT) in HCV-positive patients is almost universal. Severity of graft hepatitis increases during the long-term follow-up, and up to 30% of patients develop severe graft hepatitis and cirrhosis. However, there are still no clear predictors for severe recurrence. The aim of this study was to examine the 10-year outcome and risk factors for graft failure caused by HCV recurrence. METHODS: In a prospective analysis, 234 OLTs in 209 HCV-positive patients with a median age of 53 years were analyzed. Immunosuppression was based on cyclosporine A or tacrolimus in different protocols. Predictors for outcome were genotype, viremia, donor variables, recipient demographics, postoperative immunosuppression, and human leukocyte antigen (HLA) compatibilities. RESULTS: Actuarial 5-, and 10-year patient survival was 75.8% and 68.8%. Eighteen of 209 (8.7%) patients died because of HCV recurrence, which was responsible for 35.9% of the total 53 deaths. Significant risk factors for HCV-related graft failure in an univariate analysis were multiple steroid pulses, use of OKT3, and donor age greater than 40. However, in a multivariate analysis, multiple rejection treatments with steroids and OKT3 treatment proved to be significantly associated with HCV-related graft loss. CONCLUSIONS: The analysis of causes leading to graft failure in patients with HCV showed that HCV recurrence is responsible for one of three deaths in HCV-positive patients. Rejection treatment contributed significantly to an enhanced risk for HCV-related graft loss. New antiviral treatments, as well as adapted immunosuppressive protocols, will be necessary to further improve the outcome of HCV-positive patients after liver transplantation. SN - 0041-1337 UR - https://www.unboundmedicine.com/medline/citation/14742986/Long_term_outcome_of_liver_transplants_for_chronic_hepatitis_C:_a_10_year_follow_up_ L2 - http://Insights.ovid.com/pubmed?pmid=14742986 DB - PRIME DP - Unbound Medicine ER -