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Risk stratification of allograft failure secondary to hepatitis C recurrence after liver transplantation
Author(s) -
Shiba Hiroaki,
Hashimoto Koji,
Kelly Dympna,
Fujiki Masato,
Quintini Cristiano,
Aucejo Federico,
Uso Teresa Diago,
Yerian Lisa,
Yanaga Katsuhiko,
Matsushima Masato,
Eghtesad Bijan,
Fung John,
Miller Charles
Publication year - 2016
Publication title -
hepatology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.123
H-Index - 75
eISSN - 1872-034X
pISSN - 1386-6346
DOI - 10.1111/hepr.12661
Subject(s) - medicine , hepatitis c virus , liver transplantation , hepatitis c , gastroenterology , cirrhosis , risk factor , body mass index , transplantation , population , retrospective cohort study , surgery , immunology , virus , environmental health
Aim Hepatitis C virus (HCV) recurrence after liver transplantation decreases survival rates. Improved understanding of the multiple factors influencing HCV recurrence could aid decision‐making for donor–recipient pairing and maximize transplant outcomes. The aim of this study was to create a model based on pretransplant variables to stratify patients at risk of HCV‐related allograft failure. Methods This retrospective study enrolled 154 liver transplant recipients with HCV at Cleveland Clinic. Results Among the study population, 54 recipients (35.1%) experienced HCV recurrence, histologically defined as moderate to severe hepatitis and/or bridging fibrosis to cirrhosis. The multivariate analysis found donor age (≥60 years, P < 0.002), donor body mass index (≥30 kg/m 2 , P < 0.05), African American recipient ( P < 0.01) and genotype 1 ( P < 0.02) as risk factors for HCV‐related allograft failure. When these four factors were scored as a combined index (no factor [ n = 15], one factor [ n = 76], two factors [ n = 43] and three or more factors [ n = 20]), the HCV recurrence‐free survival showed good stratification according to the scores: 93.3% with no factor, 79.3% with one factor, 52.0% with two factors and 24.4% with three or more factors at 3 years after transplant ( P < 0.0001). Moreover, this risk index also identified the patient group at high risk of HCV recurrence after acute rejection. Conclusion While the introduction of direct‐acting antiviral agents has been changing the paradigm of HCV treatment, the natural history of recipients with HCV as shown in this study would help estimate the risk of HCV‐related allograft failure in those who do not tolerate such new treatment.