Natural history of clinically compensated hepatitis C virus-related graft cirrhosis after liver transplantation

The natural history of clinically compensated hepatitis C virus (HCV) cirrh osis after liver transplantation is unknown. This information is relevant t o transplant centers to improve the management of these patients and decide the optimal timing for retransplantation. The aims of the study were (1) t o describe the natural history of patients with HCV-cirrhosis transplants i n a center with annual liver biopsies, and (2) to determine predictors for clinical decompensation, retransplantation, and mortality rates. A total of 49 patients with HCV-graft cirrhosis, 39 clinically compensated at histolo gic diagnosis of cirrhosis (post-liver transplantation cirrhosis) were incl uded and followed up for 1 year (15 days-3.5 years). All patients tested we re infected with genotype 1b. Predictive variables included histologic acti vity index (HAI) at post-liver transplantation cirrhosis, liver function te sts, age, sex, and maintenance immunosuppression. Eighteen of 39 patients d eveloped at least 1 episode of decompensation after a median of 7.8 months (4 days-2.6 years; 93% ascites). The cumulative probability of decompensati on was 8%, 17%, and 42% at 1, 6, and 12 months, respectively. Graft and pat ient survival rates were 100%, 85%, and 71% and 100%, 92%, and 74% at 1, 6, and 12 months, respectively. Patient survival rates dropped significantly once decompensation developed (93%, 61%, and 41% at 1, 6, and 12 months, re spectively). Variables associated with decompensation, retransplantation, a nd mortality rate included a high Child-Pugh score (> A), low levels of alb umin at post-liver transplantation cirrhosis, and a short interval between liver transplantation and post-liver transplantation cirrhosis. The natural history of clinically compensated HCV-graft cirrhosis is shortened when co mpared with immunocompetent patients. If retransplantation is considered, i t should be performed promptly once decompensation develops.