Influence of antiviral therapy in the long‐term outcome of recurrent hepatitis C virus infection following liver transplantation

Severity of recurrent hepatitis C virus ( HCV ) infection in liver transplant recipients ( LTR ) is variable and the influence of different factors, including the administration of antiviral therapy in the long‐term outcome is controversial. Methods We analyzed the outcome of a cohort of HCV ‐infected LTR who were transplanted in our institution. Patients were divided into 2 groups (severe and non‐severe HCV disease) depending on the presence of a fibrosis score of F ≥2 in the Scheuer index and/or fibrosing cholestasic hepatitis ( FCH ) in a graft biopsy. Risk factors were studied using logistic regression analysis. Survival of patients was estimated using K aplan– M eier plots. A total of 146 patients were followed for a mean of 58 months. Results Fifty‐six (34%) patients developed severe HCV disease and showed shorter survival ( P  < 0.024). Donor age (odds ratio [OR]: 1.04; 95% confidence interval [CI]: 1.02–1.06) and pre‐transplant viral load ( VL ) >10 6  UI/mL (OR: 3.5; 95% CI: 1.42–10.61) were the only factors associated with severe HCV infection. Over‐immunosuppression ( OR : 2.3; 95% CI: 1.2–4.41) was specifically associated with the development of FCH . Overall, patient survival in recipients who received a full course of anti‐ HCV therapy was higher than in patients who did not complete antiviral therapy ( P  = 0.004) or received no treatment ( P  = 0.007). Patients with non‐severe HCV infection have a higher probability of receiving a full course of antiviral therapy ( P  = 0.033). Conclusion In conclusion, donor age, pre‐transplant VL , and over‐immunosuppression were associated with the long‐term development of severe HCV recurrence in liver grafts. Administration of a full course of antiviral therapy was associated with better survival.