Prolonged rewarming time during allograft implantation predisposes to recurrent hepatitis C infection after liver transplantation

The majority of patients undergoing orthotopic liver transplantation (OLT) have end-stage liver disease secondary to hepatitis C virus (HCV) infection . Although OLT does not cure the disease and recurrent virus is present in all patients, relatively few patients with recurrent viremia develop clinic al disease. When the disease recurs, however, the results can be devastatin g, Factors associated with increased risk for recurrent HCV disease remain controversial. We hypothesized that preservation injury may predispose to t he severity of HCV disease after OLT. We reviewed our series of OLTs perfor med for HCV cirrhosis between January 1994 and December 1998 (n = 56; 62 tr ansplants). Patients were grouped according to the severity of recurrent he patitis C. Group I had no or mild HCV disease (n = 36), and group 2 had mod erate to severe HCV disease (n = 20), The duration of ischemic rewarming du ring graft implantation was significantly associated with the severity of r ecurrent hepatitis C (P <.04), The estimated chances of severe disease with in the first year post-OLT after 30, 60, or 90 minutes of ischemic rewarmin g time were 19%, 40%, and 65%, respectively Cold ischemia time, transaminas e levels, and prothrombin time did not correlate with the severity of hepat itis C, In conclusion, our data suggest that the duration of ischemic rewar ming predisposes to severe recurrent hepatitis C, This finding warrants the investigation of the pathogenesis of recurrent HCV disease after ischemic injury, Reduction of rewarming time should be stressed in OLT, particularly in patients with HCV cirrhosis.