European collaborative study on factors influencing outcome after liver transplantation for hepatitis C

Background & Aims: Liver transplantation for hepatitis C virus (HCV)-relate d liver disease is characterized by frequent graft infection by HCV. The pr ognosis and risk factors for morbidity and mortality in this condition were determined. Methods: A retrospective study of 652 consecutive anti-HCV-pos itive patients undergoing liver transplantation between 1984 and 1995 in 15 European centers was conducted; 102 patients coinfected with hepatitis B v irus (HBV) received immunoglobulin prophylaxis for antibody to hepatitis B surface antigen. Results: Overall, 5-year survival was 72%. Five-year actua rial rates of hepatitis and cirrhosis were 80% and 10%. Genotypes 1b, 1a, a nd 2 were detected in 214 (80%), 24 (9%), and 24 (9%) of 268 patients analy zed. The only discriminant factor for patient or graft survival was hepatoc ellular carcinoma as primary indication. Independent risk factors for recur rent hepatitis included the absence of HBV coinfection before transplantati on (relative risk [RR], 1.7; 95% confidence interval [CI], 1.2-2.6; P = 0.0 05), genotype Ib (RR, 2; 95% CI, 1.3-2.9; P = 0.01), and age > 49 years (RR , 1.4; 95% CI, 1.1-1.8; P = 0.01). Conclusions: The results of transplantat ion for HCV-related disease are compromised by a significant risk of cirrho sis, although 5-year survival is satisfactory. Genotype 1b, age, and absenc e of pretransplantation coinfection by HBV are risk factors for recurrent H CV.