Hepatitis C is now the most common indication for orthotopic liver transplantation.
While graft reinfection remains universal, progression to graft cirrhosis is highly variable.
Dr Andrew Cameron and colleagues examined donor, recipient, and operative variables in orthotopic liver transplantation.
The research team identified factors that affect recurrence of Hepatitis C post-orthotopic liver transplantation to facilitate graft-recipient matching.
The team retrospectively reviewed 307 patients who underwent orthotopic liver transplantation for Hepatitis C over a 10-year period.
Recurrence of Hepatitis C was identified by the presence of biochemical graft dysfunction and concurrent liver biopsy showing diagnostic pathologic features.
Time to recurrence was the endpoint for statistical analysis.
The researchers analyzed 5 donor, 6 recipient, and 2 operative variables that may affect recurrence.
|Recurrence-free survival in the 307 patients was 34% at 5 years|
|Annals of Surgery|
The team used univariate comparison and Cox proportional hazard regression models.
Recurrence-free survival in the 307 study patients was 69% and 34% at 1 and 5 years, respectively.
The team identified 4 predictive variables related to either donor or recipient characteristics.
Advanced donor age, and prolonged donor hospitalization increased the relative risk of Hepatitis C recurrence.
The team also found that increasing recipient age, and elevated recipient MELD scores increased the relative risk of Hepatitis C recurrence.
Human leukocyte antigen disparity between donors and recipients showed no correlation between class I or class II mismatches and recurrence-free survival.
Dr Cameron's team concludes, “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 Hepatitis C recipients, may decrease the incidence of Hepatitis C recurrence after orthotopic liver transplantation.
“A change in the current national liver allocation system would be needed to realize the full value of this benefit.”