Mortality Predictors in LT Recipients With Recurrent HCV
Mortality Predictors in LT Recipients With Recurrent HCV
Background/Aim: Recipients of orthotopic liver transplant for hepatitis C (HCV) invariably develop recurrent disease. The risk factors for death and retransplantation following the development of cirrhosis from HCV are unclear. The aim of this study was to identify predictors of survival in liver transplant recipients who develop cirrhosis from recurrent HCV.
Methods: We reviewed records of patients who underwent liver transplantation for cirrhosis due to HCV between January 1990 and December 2001. Prognostic factors of patient survival following the development of recurrent cirrhosis were identified through multivariate analysis.
Results: During the study period, 511 patients underwent transplantation for HCV cirrhosis. Of these, 65 patients (13%) developed biopsy proven recurrent cirrhosis from HCV; 43 (8%) were relisted for transplantation, and 24 (5%) underwent retransplantation. The overall Kaplan–Meier patient survival rates after the histologic diagnosis of cirrhosis at 1 and 5 years were 66% and 30%, respectively. A multivariate Cox proportional hazards model showed patients with higher last (i.e. at follow-up or prior to retransplantation) International normalized ratio (INR) values (hazard ratios (HR) = 2.02, 95% confidence interval 1.26, 3.24, P < 0.01) to have an increased risk of death.
Conclusion: Our Results suggested survival was decreased after the diagnosis of cirrhosis from recurrent HCV. Higher INR was associated with an increased risk of death following the development of cirrhosis.
Hepatitis C (HCV) is currently the leading indication for orthotopic liver transplantation (OLT) in the United States. In 1997, between 8000 and 10 000 patients died of HCV cirrhosis. The number of deaths per year is projected to increase to 17 000 between 2010 and 2019. The absolute number and relative proportion of transplants for HCV are likely to increase in the next decade, as a large cohort of infected individuals begin to seek medical care.
Recurrent HCV disease is accelerated following OLT. After the first year, more than a quarter of patients show some degree of histologic damage; at 3 years, the percentage increases to 80%. Cirrhosis can develop in 10% to 20% of liver transplant recipients after 5 years. In contrast, 20% of individuals from the general population develop cirrhosis after two decades of infection. There are a number of factors associated with fibrosis progression after liver transplantation, including donor age and multiple steroid pulses. Decompensation also appears to be accelerated after the development of cirrhosis. The probabilities of decompensation at 6 and 12 months are 17% and 42%, respectively.
However, the mortality predictors after the development of cirrhosis are unclear. Thus, in the current study we identify predictive factors of patient survival in liver transplant recipients who developed cirrhosis. The Results may help estimate prognosis in patients with cirrhosis from recurrent HCV after liver transplantation.
Background/Aim: Recipients of orthotopic liver transplant for hepatitis C (HCV) invariably develop recurrent disease. The risk factors for death and retransplantation following the development of cirrhosis from HCV are unclear. The aim of this study was to identify predictors of survival in liver transplant recipients who develop cirrhosis from recurrent HCV.
Methods: We reviewed records of patients who underwent liver transplantation for cirrhosis due to HCV between January 1990 and December 2001. Prognostic factors of patient survival following the development of recurrent cirrhosis were identified through multivariate analysis.
Results: During the study period, 511 patients underwent transplantation for HCV cirrhosis. Of these, 65 patients (13%) developed biopsy proven recurrent cirrhosis from HCV; 43 (8%) were relisted for transplantation, and 24 (5%) underwent retransplantation. The overall Kaplan–Meier patient survival rates after the histologic diagnosis of cirrhosis at 1 and 5 years were 66% and 30%, respectively. A multivariate Cox proportional hazards model showed patients with higher last (i.e. at follow-up or prior to retransplantation) International normalized ratio (INR) values (hazard ratios (HR) = 2.02, 95% confidence interval 1.26, 3.24, P < 0.01) to have an increased risk of death.
Conclusion: Our Results suggested survival was decreased after the diagnosis of cirrhosis from recurrent HCV. Higher INR was associated with an increased risk of death following the development of cirrhosis.
Hepatitis C (HCV) is currently the leading indication for orthotopic liver transplantation (OLT) in the United States. In 1997, between 8000 and 10 000 patients died of HCV cirrhosis. The number of deaths per year is projected to increase to 17 000 between 2010 and 2019. The absolute number and relative proportion of transplants for HCV are likely to increase in the next decade, as a large cohort of infected individuals begin to seek medical care.
Recurrent HCV disease is accelerated following OLT. After the first year, more than a quarter of patients show some degree of histologic damage; at 3 years, the percentage increases to 80%. Cirrhosis can develop in 10% to 20% of liver transplant recipients after 5 years. In contrast, 20% of individuals from the general population develop cirrhosis after two decades of infection. There are a number of factors associated with fibrosis progression after liver transplantation, including donor age and multiple steroid pulses. Decompensation also appears to be accelerated after the development of cirrhosis. The probabilities of decompensation at 6 and 12 months are 17% and 42%, respectively.
However, the mortality predictors after the development of cirrhosis are unclear. Thus, in the current study we identify predictive factors of patient survival in liver transplant recipients who developed cirrhosis. The Results may help estimate prognosis in patients with cirrhosis from recurrent HCV after liver transplantation.
Source...