PREDICTORS OF PATIENT AND GRAFT-SURVIVAL FOLLOWING LIVER-TRANSPLANTATION FOR HEPATITIS-C

End-stage liver disease secondary to hepatitis C virus (HCV) infection is the leading indication for liver transplantation in the United Sta tes. Recurrence of HCV infection is nearly universal. We studied the p atients enrolled in the National Institute of Diabetes and Digestive a nd Kidney Diseases Liver Transplantation Database to determine whether pretransplantation patient or donor variables could identify a subset of HCV-infected recipients with poor patient survival. Between April 15, 1990, and June 30, 1944, 166 HCV-infected and 509 HCV-negative pat ients underwent liver transplantation at the participating institution s. Median follow-up was 5.0 years for HCV-infected and 5.2 years for H CV-negative recipients. Pretransplantation donor and recipient charact eristics, and patient and graft survival, were prospectively collected and compared. Cumulative patient survival for HCV-infected recipients was similar to that of recipients transplanted for chronic non-B-C he patitis, or alcoholic and metabolic liver disease, better than that of patients transplanted for malignancy or hepatitis B (P =.02 and P =.0 03, respectively), and significantly worse than that of patients trans planted for cholestatic liver disease (P =.001), Recipients who had a pretransplantation HCV-RNA titer of greater than or equal to 1 x 10(6) vEq/mL had a cumulative 5-year survival of 57% versus 84% for those w ith HCV-RNA titers of <1 x 106 vEq/mL (P =.0001), Patient and graft su rvival did not vary with recipient gender, HCV genotype, or induction immunosuppression regimen among the HCV-infected recipients. While lon gterm patient and graft survival following liver transplantation for e nd-stage liver disease secondary to HCV are generally comparable with that of most other indications, higher pretransplantation HCV-RNA tite rs are strongly associated with poor survival among HCV-infected recip ients.