Factors that identify survival after liver retransplantation for allograft failure caused by recurrent hepatitis C infection

Guy W. Neff, Christopher B O'Brien, Jose Nery, Norah J. Shire, Seigo Nishida, Julia delaGarza, Marzia Montalbano, Kamran Safdar, Phillip Ruiz, Eric Rideman, Jose A. Gascon, Andreas G. Tzakis, Juan Madariaga, Steven M. Rudich

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

Hepatitis C virus (HCV) is becoming the most common indication for liver retransplantation (ReLTx). This study was a retrospective review of the medical records of liver transplant patients at our institution to determine factors that would identify the best candidates for ReLTx resulting from allograft failure because of HCV recurrence. The patients were divided into 2 groups on the basis of indication for initial liver transplant. Group 1 included ReLTx patients whose initial indication for LTx was HCV. Group 2 included patients who received ReLTx who did not have a history of HCV. We defined chronic allograft dysfunction (AD) as patients with persistent jaundice (> 30 days) beginning 6 months after primary liver transplant in the absence of other reasons. HCV was the primary indication for initial orthotopic liver transplantation (OLT) in 491/1114 patients (44%) from July 1996 to February 2004. The number of patients with AD undergoing ReLTx in Groups 1 and 2 was 22 and 12, respectively. The overall patient and allograft survival at 1 year was 50% and 75% in Groups 1 and 2, respectively (P = .04). The rates of primary nonfunction and technical problems after ReLTx were not different between the groups. However, the incidence of recurrent AD was higher in Group 1 at 32% versus 17% in Group 2 (P = .04). Important factors that predicted a successful ReLTx included physical condition at the time of ReLTx (P = .002) and Child-Turcotte-Pugh score (P = .008). In conclusion, HCV is associated with an increased incidence of chronic graft destruction with a negative effect on long-term results after ReLTx. The optimum candidate for ReLTx is a patient who can maintain normal physical activity. As the allograft shortage continues, the optimal use of cadaveric livers continues to be of primary importance. The use of deceased donor livers in patients with allograft failure caused by HCV remains a highly controversial issue.

Original languageEnglish
Pages (from-to)1497-1503
Number of pages7
JournalLiver Transplantation
Volume10
Issue number12
DOIs
StatePublished - Dec 1 2004

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Hepatitis C
Allografts
Hepacivirus
Survival
Liver
Infection
Transplants
Incidence
Jaundice
Liver Transplantation
Medical Records
Tissue Donors
Exercise
Recurrence

ASJC Scopus subject areas

  • Surgery
  • Transplantation

Cite this

Factors that identify survival after liver retransplantation for allograft failure caused by recurrent hepatitis C infection. / Neff, Guy W.; O'Brien, Christopher B; Nery, Jose; Shire, Norah J.; Nishida, Seigo; delaGarza, Julia; Montalbano, Marzia; Safdar, Kamran; Ruiz, Phillip; Rideman, Eric; Gascon, Jose A.; Tzakis, Andreas G.; Madariaga, Juan; Rudich, Steven M.

In: Liver Transplantation, Vol. 10, No. 12, 01.12.2004, p. 1497-1503.

Research output: Contribution to journalArticle

Neff, GW, O'Brien, CB, Nery, J, Shire, NJ, Nishida, S, delaGarza, J, Montalbano, M, Safdar, K, Ruiz, P, Rideman, E, Gascon, JA, Tzakis, AG, Madariaga, J & Rudich, SM 2004, 'Factors that identify survival after liver retransplantation for allograft failure caused by recurrent hepatitis C infection', Liver Transplantation, vol. 10, no. 12, pp. 1497-1503. https://doi.org/10.1002/lt.20301
Neff, Guy W. ; O'Brien, Christopher B ; Nery, Jose ; Shire, Norah J. ; Nishida, Seigo ; delaGarza, Julia ; Montalbano, Marzia ; Safdar, Kamran ; Ruiz, Phillip ; Rideman, Eric ; Gascon, Jose A. ; Tzakis, Andreas G. ; Madariaga, Juan ; Rudich, Steven M. / Factors that identify survival after liver retransplantation for allograft failure caused by recurrent hepatitis C infection. In: Liver Transplantation. 2004 ; Vol. 10, No. 12. pp. 1497-1503.
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abstract = "Hepatitis C virus (HCV) is becoming the most common indication for liver retransplantation (ReLTx). This study was a retrospective review of the medical records of liver transplant patients at our institution to determine factors that would identify the best candidates for ReLTx resulting from allograft failure because of HCV recurrence. The patients were divided into 2 groups on the basis of indication for initial liver transplant. Group 1 included ReLTx patients whose initial indication for LTx was HCV. Group 2 included patients who received ReLTx who did not have a history of HCV. We defined chronic allograft dysfunction (AD) as patients with persistent jaundice (> 30 days) beginning 6 months after primary liver transplant in the absence of other reasons. HCV was the primary indication for initial orthotopic liver transplantation (OLT) in 491/1114 patients (44{\%}) from July 1996 to February 2004. The number of patients with AD undergoing ReLTx in Groups 1 and 2 was 22 and 12, respectively. The overall patient and allograft survival at 1 year was 50{\%} and 75{\%} in Groups 1 and 2, respectively (P = .04). The rates of primary nonfunction and technical problems after ReLTx were not different between the groups. However, the incidence of recurrent AD was higher in Group 1 at 32{\%} versus 17{\%} in Group 2 (P = .04). Important factors that predicted a successful ReLTx included physical condition at the time of ReLTx (P = .002) and Child-Turcotte-Pugh score (P = .008). In conclusion, HCV is associated with an increased incidence of chronic graft destruction with a negative effect on long-term results after ReLTx. The optimum candidate for ReLTx is a patient who can maintain normal physical activity. As the allograft shortage continues, the optimal use of cadaveric livers continues to be of primary importance. The use of deceased donor livers in patients with allograft failure caused by HCV remains a highly controversial issue.",
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