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 18 November 2017

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News

Poor survival after liver retransplantation

Survival after liver retransplantation is inferior to that for primary transplantation, but appears to have improved in recent years, find doctors in the September issue of Liver Transplantation.

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The prevalence of hepatitis C virus (HCV) infection in repeated orthotopic liver transplantation (re-OLT) is increasing. Patient survival may be worse.

In this study, doctors from the United States assessed the prevalence of HCV in re-OLT. They also compared survival between primary OLT and re-OLT for HCV versus non-HCV diseases, and evaluated Model for End-Stage Liver Disease (MELD) scores in re-OLT.

The team analyzed data from the United Network for Organ Sharing database. Patients with malignancy or those who underwent re-OLT within 30 days of primary OLT were excluded.

During the study period a total of 22,120 primary OLTs and 2129 re-OLTs were performed.
Survival after retransplantation was no different for patients with HCV.
Liver Transplantation

The team found that HCV occurred in 43% of primary OLTs and 42% re-OLTs.

They determined that the overall 1-, 3-, and 5-year patient survival rates were 86%, 79%, and 73%, respectively, for primary OLT. However, these rates fell to 67%, 56%, and 52% for re-OLT.

They also determined that the survival rates of patients with HCV at 1, 3, and 5 years were 86%, 76%, and 68%, respectively, for primary OLT. These rates dropped for re-OLT to 61%, 50%, and 45%.

The researchers confirmed that re- OLT survival for patients with HCV was less than for those with autoimmune hepatitis and hepatitis B.

However, survival after re-OLT was no different for those with HCV than for those with all other causes.

The team also found that MELD scores between 11 and 20 were the most common for re-OLT.

A marked decreased in survival was noted in all patients who underwent re-OLT with MELD scores greater than 25.

Dr Kymberly Watt's team concluded, "HCV prevalence in OLT has reached a plateau in recent years".

"Survival after re-OLT is inferior to that for primary OLT, but re-OLT survival appears to have improved".

"Survival after re-OLT is lower in patients with HCV compared with those with autoimmune hepatitis and hepatitis B, but no different than for those with most other liver diseases".

"Survival appeared worse in patients who underwent re-OLT with a MELD score greater than 25".

Liver Transpl 2003; 9: 1019-24
07 October 2003

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