LIVER-TRANSPLANTATION FOR HEPATITIS C-ASSOCIATED CIRRHOSIS IN A SINGLE AUSTRALIAN CENTER - REFERRAL PATTERNS AND TRANSPLANT OUTCOMES

During the study period, 63 patients with hepatitis C virus (HCV) cirr hosis were referred to our unit for liver transplantation. All cases r eferred and transplanted were retrospectively examined. Eighty-six per cent of referred patients were male, 35% consumed alcohol in the harm ful/hazardous range, 13% were infected with hepatitis B and 7% had hep atocellular carcinoma. Patients with sporadic infection were more like ly to be born outside Australia and were an average of 10 years older than those with HCV acquired via intravenous drug use (P< 0.001). Howe ver, patients were an average of 12 years younger at referral if they consumed harmful amounts of alcohol than if they abstained (P = 0.002) . We examined the impact of HCV on the outcome of 28 patients who unde rwent liver transplantation (mean follow up 25 months; range 3-76 mont hs). The use of OKT3, HCV genotype and hepatitis B status were examine d for their effect on HCV-related graft dysfunction. Three year surviv al was 84%, equivalent to a control group. Chronic HCV-related graft d ysfunction occurred in 15 (56%) patients, of whom 10 had an asymptomat ic elevation in serum amino transferase, two had cholestatic hepatitis and three had severe hepatitis C that progressed onto chronic rejecti on. Hepatitis C virus genotype 1b tended to be associated with HCV gra ft dysfunction (5/6 type 1b vs 10/16 in non-type 1b). In conclusion, H CV is an increasingly common indication for liver transplantation. Alc ohol and hepatitis B were frequently occurring cofactors in the referr al cohort. Most patients referred were male, although the reason why i s not clear. Transplantation offers a good medium-term outcome, despit e the high incidence of HCV-associated graft dysfunction.