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Survival after liver transplantation for hepatocellular carcinoma in the model for end‐stage liver disease and pre–model for end‐stage liver disease eras and the independent impact of hepatitis C virus
Author(s) -
Thuluvath Paul J.,
Maheshwari Anurag,
Thuluvath Nimisha P.,
Nguyen Geoffrey C.,
Segev Dorry L.
Publication year - 2009
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.21744
Subject(s) - medicine , hepatocellular carcinoma , hepatitis c virus , liver transplantation , hepatitis c , gastroenterology , liver disease , model for end stage liver disease , stage (stratigraphy) , survival rate , transplantation , immunology , virus , paleontology , biology
It has been suggested that hepatitis C virus (HCV) patients with hepatocellular carcinoma (HCC) may have worse outcomes after liver transplantation (LT) because of more aggressive tumor biology. In this study, we determined the post‐LT survival of HCC patients with and without HCV using United Network for Organ Sharing data from January 1994 to March 2008. Patients with HCC were stratified into HCV (HCC‐HCV) and non‐HCV (HCC–non‐HCV) groups. In the era before the Model for End‐Stage Liver Disease (MELD), there were 1237 HCC patients (780, HCV; 373, non‐HCV; 84, unknown HCV status), and during the MELD era, there were 4933 HCC patients (3272, HCV; 1348, non‐HCV; 313, unknown). In the pre‐MELD era, 5‐year graft (58.6% versus 53.7%) and patient (61.7% versus 59.3%) survival rates were marginally higher for HCC–non‐HCV patients than for HCC‐HCV patients. In the MELD era also, 5‐year graft (61.2% versus 55.5%) and patient (63.7% versus 58.2%) survival rates were marginally higher for HCC–non‐HCV patients than for HCC‐HCV patients. In patients without HCC, pre‐MELD and MELD era graft/patient survival rates for non‐HCV patients were higher than those for HCV patients. The differences in survival rates for HCC patients with and without HCV were lower than those for non‐HCC patients stratified by their HCV status. HCV had no additional negative impact on the post‐LT survival of patients with HCC, and this was further confirmed by multivariate analysis. In conclusion, the survival of HCC patients has remained unchanged in the past 2 decades. HCV patients have a lower survival rate than non‐HCV patients, regardless of their HCC status, but HCV has no additional negative impact on survival in patients with HCC. Liver Transpl 15:754–762, 2009. © 2009 AASLD.