Non-viral Factors Associated with HCV Recurrence after Liver Transplantation

Hepatitis C can cause long-term liver damage, including advanced cirrhosis and hepatocellular carcinoma, which sometimes necessitates a liver transplant. Unfortunately, hepatitis C virus (HCV) usually re-infects the new donor liver graft not long after transplantation.

In the present study, reported in the October 2006 Annals of Surgery, researchers conducted a retrospective review of factors associated with hepatitis C recurrence and liver disease progression in 307 patients who underwent orthotopic liver transplantation (OLT) over a 10-year period at the University of California at Los Angeles Liver Transplant Center. Recurrence of HCV was identified by the presence of biochemical graft dysfunction and concurrent liver biopsy showing pathological features.

Results

Recurrence-free survival for the 307 participants was 69% at 1 year and 34% at 5 years after transplantation.

4 predictive variables related to either donor or recipient characteristics were associated with an increased relative risk of post-transplant HCV recurrence:

- Advanced donor age;
- Prolonged donor hospitalization;
- Increased recipient age;
- Elevated recipient MELD score (a measure of liver disease severity used to prioritize patients for transplantation).

Examination of HLA disparity (genetic mismatch) between donors and recipients demonstrated no correlation between Class I or Class II mismatches and recurrence-free survival.

Conclusion

In conclusion, the authors wrote, "We have identified donor and recipient characteristics that significantly predict hepatitis C recurrence following liver transplantation."

"These factors are identifiable before transplant and, if considered when matching donors to HCV recipients, may decrease the incidence of HCV recurrence after OLT," they continued, adding that, "A change in the current national liver allocation system would be needed to realize the full value of this benefit."

10/13/06

Reference
A M Cameron, R M Ghobrial, J R Hiatt, and others. Effect of Nonviral Factors on Hepatitis C Recurrence After Liver Transplantation. Annals of Surgery. Scientific Papers of the 126th Annual Meeting of the American Surgical Association. 244(4): 563-571, October 2006.