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 27 May 2018

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Hepatic iron overload reduces liver transplant survival

Research in August's issue of Gastroenterology has confirmed that 1- and 5-year survival after liver transplant is lower in patients with hepatic iron overload, presenting with or without HFE-associated hemochromatosis.

News image

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Previous uncontrolled studies have suggested that patients with hepatic iron overload have a poor outcome after liver transplantation.

Dr Kris Kowdley and colleagues examined the effect of HFE mutations on post-transplantation survival in patients with hepatic iron overload.

The researchers enrolled 260 patients with end-stage liver disease and hepatic iron overload from 12 liver transplantation centers.

The team recorded hepatic iron concentration, hepatic iron index, HFEmutation status, and survival after liver transplantation.

HFE-associated hemochromatosis was defined in 14 patients as homozygosity for the C282Y mutation.

In 11 patients, the team defined HFE-associated hemochromatosis as compound heterozygosity for the C282Y/H63D mutation.

The HFE-associated hemochromatosis mutations were identified in 13% of patients.

After age adjustment, HFE-associated hemochromatosis had a hazard ratio for death of 3
Gastroenterology

The researchers found that survival post-liver transplantation was significantly lower among patients with HFE-associated hemochromatosis.

The 1-, 3-, and 5-year survival rates in these patients were 64%, 48%, 34%, respectively compared with simple heterozygotes or wild-type patients.

The researchers observed that patients with HFE-associated hemochromatosis had a hazard ratio for death of 3 after adjustment for age.

The hazard ratio for mortality remained the same after adjusting for United Network for Organ Sharing status, year of transplantation, and either elevated hepatic iron index or iron concentration.

The team noted that non-HFE-associated hemochromatosis patients with hepatic iron overload had decreased survival versus the overall population undergoing liver transplantation.

Dr Kowdley's team concludes, “1- and 5-year survivals after liver transplantation are significantly lower among patients with HFE-associated hemochromatosis.

“Our data also suggest that hepatic iron overload may be associated with decreased survival after liver transplantation, even in patients without HFE-associated hemochromatosis.”

“Early diagnosis of hepatic iron overload using HFE-associated hemochromatosis gene testing and iron depletion prior to liver transplantation may improve post-transplantation survival, particularly among patients with HFE-associated hemochromatosis.”

Gastroenterol 2005: 129(2): 494-503
05 August 2005

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