Premium
Negativization of viremia prior to liver transplant reduces early allograft dysfunction in hepatitis C–positive recipients
Author(s) -
Martini Silvia,
Tandoi Francesco,
Terzi di Bergamo Lodovico,
Strona Silvia,
Lavezzo Bruna,
Sacco Marco,
Maione Francesca,
Gonella Federica,
Strignano Paolo,
Dell Olio Dominic,
Salizzoni Mauro,
Saracco Giorgio Maria,
Romagnoli Renato
Publication year - 2017
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.24772
Subject(s) - medicine , hepatocellular carcinoma , gastroenterology , liver transplantation , viremia , bilirubin , liver disease , hepatitis c virus , alanine transaminase , hepatitis c , transplantation , surgery , immunology , virus
Although early allograft dysfunction (EAD) negatively impacts survival from the first months following liver transplantation (LT), direct‐acting antiviral agents (DAAs) have revolutionized hepatitis C virus (HCV) therapy. We investigated the EAD definition best predicting 90‐day graft loss and identified EAD risk factors in HCV‐positive recipients. From November 2002 to June 2016, 603 HCV‐positive patients (hepatocellular carcinoma, 53.4%) underwent a first LT with HCV‐negative donors. The median recipient Model for End‐Stage Liver Disease (MELD) score was 15, and the median donor age was 63 years. At LT, 77 (12.8%) patients were HCV RNA negative; negativization was achieved and maintained by pre‐LT antiviral therapy (61 patients) or pre‐LT plus a pre‐emptive post‐LT course (16 patients); 60 (77.9%) patients received DAAs and 17 (22.1%) interferon. We compared 3 different EAD definitions: (1) bilirubin ≥ 10 mg/dL or international normalized ratio ≥ 1.6 on day 7 after LT or aspartate aminotransferase or alanine aminotransferase > 2000 IU/L within 7 days of LT; (2) bilirubin > 10 mg/dL on days 2‐7 after LT; and (3) MELD ≥ 19 on day 5 after LT. EAD defined by MELD ≥ 19 on day 5 after LT had the lowest negative (0.1) and the highest positive (1.9) likelihood ratio to predict 90‐day graft loss. At 90 days after LT, 9.2% of recipients with EAD lost their graft as opposed to 0.7% of those without EAD ( P < 0.001). At multivariate analysis, considering variables available at LT, MELD at LT of >25 (OR = 7.4) or 15‐25 (OR = 3.2), graft macrovesicular steatosis ≥ 30% (OR = 6.7), HCV RNA positive at LT (OR = 2.7), donor age > 70 years (OR = 2.0), earlier LT era (OR = 1.8), and cold ischemia time ≥ 8 hours (OR = 1.8) were significant risk factors for EAD. In conclusion, in HCV‐positive patients, MELD ≥ 19 on day 5 after LT best predicts 90‐day graft loss. Preventing graft infection by pre‐/peri‐LT antiviral therapy reduces EAD incidence and could be most beneficial in high‐MELD patients and recipients of suboptimal grafts. Liver Transplantation 23 915–924 2017 AASLD.