HISTOLOGICAL AND CLINICAL OUTCOME AFTER LIVER-TRANSPLANTATION FOR HEPATITIS-C

Hepatitis frequently recurs after liver transplantation for hepatitis C. However, the histological progression of disease, predictors of rec urrence and disease severity, and patient survival remain uncertain. F ifty-five patients with cirrhosis caused by chronic hepatitis C underw ent liver transplantation between January 1990 and December 1993. Hepa titis C genotype was determined, and liver biopsies were performed at frequent intervals posttransplantation. The median follow-up time was 40.4 months. The cumulative rate of survival was no different in liver transplant recipients for hepatitis C than in liver transplant recipi ents for other chronic liver diseases (P = .62). Histological recurren t hepatitis C developed in 33 of SO patients assessable for disease re currence; the median recurrence-free survival time was 13.4 months. Hi stological activity and stage were mild in most cases. Only 2 patients developed cirrhosis, and no patient required a second transplantation for recurrent disease. Patients with acute cellular rejection had a s horter recurrence-free survival (P = .0141). In patients with recurren t hepatitis, rejection also was correlated with increased histological grade 2 years after transplantation (P = .0061). Recurrence-free surv ival was decreased in patients infected with genotype 1 (la and Ib com bined) compared with genotypes 2 and 3 combined (P = .02), whereas the re was no difference between genotypes la and Ib (P > .80). Only patie nts infected with genotype la or Ib developed bridging fibrosis or cir rhosis. In addition, patients who had an early recurrence had a greate r risk of progressing to bridging fibrosis or cirrhosis (hazard ratio, 5.1; P = .0473). In our experience, recurrent hepatitis C after liver transplantation in most cases is mild and survival is unaffected. Bot h acute cellular rejection and infection with genotype 1 are independe nt risk factors for reduced recurrence-free survival, and early recurr ence is associated with a higher risk of disease progression.