Long-term outcomes for liver transplantation due to hepatitis C

A new study on liver transplants necessitated by the hepatitis C virus (the most common indication for this type of transplant) found that long-term outcomes are similar to patients receiving transplants due to other diseases. It was the first study to examine long-term transplantation results in hepatitis C patients and to identify risk factors that might lead to transplant failure or death.

The results of this study appear in the September 2004 issue of Liver Transplantation, the official journal of the American Association for the Study of Liver Diseases (AASLD) and the International Liver Transplantation Society (ILTS). The journal is published on behalf of the societies by John Wiley & Sons, Inc. and is available online via Wiley InterScience.

Unlike other liver diseases, hepatitis C infection commonly recurs in transplant patients. Although previous studies had shown that short-term transplantation survival rates for hepatitis C patients were similar to patients undergoing transplants for other indications, a recent analysis of the United Network for Organ Sharing (UNOS) database suggested that five-year transplant outcomes may be poorer for hepatitis C patients. The current study utilized the Liver Transplantation Database, which was established in 1990 by the National Institutes of Diabetes and Digestive and Kidney Diseases (NIDDK) to collect data on patients being evaluated for liver transplants.

Led by Michael Charlton, M.D. of the division of Gastroenterology & Hepatology at the Mayo Clinic in Rochester MN, researchers examined the records of 165 patients with hepatitis C who underwent liver transplants and were followed for up to 12 years post transplant. They found that these patients had 10-year outcomes similar to patients undergoing liver transplants for other reasons, that the most common cause of death or transplant failure in these patients was due to recurrence of hepatitis C, and that risk of transplant failure increased over time.

In addition, researchers examined a number of factors to see if they could be used to predict transplant success. These included recipient age, donor age, bilirubin, INR (a measure of blood-clotting capability), and viral load and the presence of cytomegalovirus (CMV) antibodies prior to transplant. Donor and recipient age were found to more strongly predict transplant failure or death, with absence of CMV antibodies and higher hepatitis C viral load also playing a role. The researchers hypothesize that all of these factors are indications of poor immunity, which would in turn lead to lower transplant success. Higher bilirubin and INR, which are associated with early death following transplant, may in turn indicate general debility in the patient. Using these factors, researchers were able to construct a model that identifies potential transplant hepatitis C patients who are at the greatest risk of early death or transplant failure.