HEPATITIS-C VIRAL-INFECTION IN LIVER-TRANSPLANTATION

Objective: To study the outcomes of patients who underwent liver trans plantation for the primary diagnosis of chronic active hepatitis secon dary to hepatitis C virus (HCV). Design and Setting: Retrospective rev iew within a university medical center. Patients: Seventy-four adult r ecipients who received 78 orthotopic liver allografts for the primary diagnosis of chronic active hepatitis secondary to HCV between January 1990 and December 1994. Sixty-seven patients (91%) survived more than 2 months and were analyzed further for recurrent HCV infection. Main Outcome Measures: Recurrence of HCV infection, hepatitis, or cirrhosis and survival rates for patients who were undergoing orthotopic liver transplantation for chronic active hepatitis secondary to HCV. Results : Actuarial survival rates for the entire group were 79.3%, 70.9%, and 64.5% at 1, 2, and 3 years, respectively. Four patients (5%) underwen t retransplantation with an actuarial survival rate of 14.3% at 1 year (P<.05). Thirty-eight patients (57%) had evidence of posttransplant H CV infection, 31 patients (46%) showed histologic evidence of viral he patitis, and 11 patients (16%) experienced portal fibrosis or cirrhosi s. Seven (33%) of the deaths and all retransplantations were secondary to recurrent HCV infection. There were no significant differences in age, sex, United Network of Organ Sharing status, associated diagnoses , intraoperative packed red blood cell requirements, OKT3 use, or 1-, 2-, and 3-year survival rates in the recurrent vs nonrecurrent HCV inf ection groups. A higher incidence of posttransplant cirrhosis was obse rved in patients who were treated with tacrolimus (FK 506) (31.8% vs 8 .9%, P<.05). Twenty-one patients (70%) received interferon alfa antivi ral therapy with a significant benefit in the liver function test resu lts during therapy (P<.01). Conclusions: Despite recurrence of HCV inf ection in most patients after transplantation, survival following prim ary orthotopic liver transplantation for chronic active hepatititis se condary to HCV infection remains favorable, and these patients should continue to be candidates for liver transplantation. Tn contrast, surv ival following retransplantation for HCV infection is poor and should be reconsidered. There is an apparent association between the intensit y of immunosuppression and recurrent HCV infection and cirrhosis that warrants continued evaluation. Interferon therapy appears to afford be nefit to patients in whom recurrent HCV hepatitis develops after trans plantation.