Liver transplantation for hepatitis C: Recurrence and disease progression in 300 patients

The time progression of allograft damage in patients with recurrent hepatit is C after orthotopic liver transplantation (OLT) is not precisely determin ed. The aim of this analysis is to study the progression of disease recurre nce and its impact on patient and graft survival. Data for 300 patients who underwent OLT for hepatitis C were analyzed regarding the incidence of his tological recurrence, risk factors, immunosuppressive regimen, rejection ep isodes, and survival. For patients with histological recurrence, the timing and risks for disease progression were analyzed. Data for 30 patients who underwent retransplantation were studied. Histological recurrence occurred in 40.3% of patients, 27.2% of whom progressed to bridging fibrosis or cirr hosis. Eighty-seven percent of the patients experienced recurrence of disea se within 24 months of OLT. Patients with histological recurrence within 6 months of OLT had an increased risk for progression to cirrhosis compared w ith patients with recurrence later than 6 months (risk ratio, 2.3). Recurre nce within I year was associated with decreased patient and graft survival rates at I and 5 years (65.1% and 56.4% versus 80.6% and 78.4%; P = .004 an d P = .0008, respectively). Patients with histological recurrence had a gre ater incidence of acute cellular rejection, as well as multiple episodes of rejection, steroid-resistant rejections, and greater cumulative doses of c orticosteroids. Histological recurrence after OLT for hepatitis C is common and usually occurs within 2 years of OLT, Early recurrence negatively affe cts patient and graft survival. Host factors impacting on recurrence need f urther study. A relation between the hepatitis C virus, allograft rejection , and immunosuppression exists and needs investigation.