LONG-TERM OUTCOME OF HEPATITIS-C INFECTION AFTER LIVER-TRANSPLANTATION

Background. End-stage cirrhosis related to hepatitis C virus (HCV) is a common reason for liver transplantation, although viremia is known t o persist in most cases. We investigated the impact of persistent HCV infection after liver transplantation on patient and graft survival an d the effects of the HCV genotype and the degree of HLA matching betwe en donor and recipient on the severity of recurrent hepatitis. Methods . A group of 149 patients with HCV infection who received liver transp lants between January 1982 and April 1994 were followed for a median o f 36 months; 623 patients without HCV infection who underwent liver tr ansplantation for end-stage chronic liver disease were used as a contr ol group, A total of 528 liver-biopsy specimens from the HCV-infected recipients were reviewed, including 82 obtained one year after transpl antation as scheduled and 39 obtained at five years as scheduled. In a ddition, biopsy specimens were obtained from 91 of the HCV-negative pa tients five years after transplantation. Results. Cumulative survival rates for the 149 patients with HCV infection were 79 percent after on e year, 74 percent after three years, and 70 percent after five years, as compared with rates of 75 percent, 71 percent, and 69 percent, res pectively, in the HCV-negative transplant recipients (P = 0.12). Of th e 130 patients with hepatitis C infection who survived more than 6 mon ths after transplantation, 15 (12 percent) had no evidence of chronic hepatitis on their most recent liver biopsy (median followup, 20 month s), 70 (54 percent) had mild chronic hepatitis (median, 35 months), 35 (27 percent) had moderate chronic hepatitis (median, 35 months), and 10 (8 percent) had cirrhosis (median, 51 months). Graft loss occurred after a median of 303 days in 27 of the 149 patients, including 5 with HCV-related cirrhosis and 3 with HCV-related cholestatic hepatitis. I nfection with HCV genotype Ib was associated with more severe graft in jury, whereas the primary immunosuppressive regimen used and the exten t of HLA mismatching between donors and recipients had no significant effect on this variable. Conclusions. After liver transplantation for HCV-related cirrhosis, persistent HCV infection can cause severe graft damage, and such damage is more frequent in patients infected with HC V genotype 1b than with other genotypes. After five years, the rates o f graft and overall survival are similar between patients with and tho se without HCV infection. (C) 1996, Massachusetts Medical Society.