Increased hepatic iron and cirrhosis: No evidence for an adverse effect onpatient outcome following liver transplantation

It has been suggested that preexisting severe hepatic iron overload may adv ersely affect outcome after liver transplantation. The pathogenesis of iron overload in cirrhosis in the absence of hemochromatosis gene (HFE) mutatio ns is poorly understood. The relationships between liver disease severity a nd etiology, degree of hepatic iron overload, and post-liver transplantatio n outcome were studied in 282 consecutive adult patients with cirrhosis. Th irty-seven percent of patients had stainable hepatic iron. Increased hepati c iron concentration was significantly associated with more severe liver di sease (P <.001), male sex (P =.05), the presence of spur cell anemia (P <.0 001), and hepatocellular liver disease (P <.0001). The HFE mutations were u ncommon in patients with increased hepatic iron stores. Increased hepatic i ron concentration was not associated with greater utilization of resources or a lower survival after liver transplantation. Child-Pugh score at the ti me of liver transplantation was the only independent variable affecting pat ient survival (P =.0008), In summary, our data suggest that the severity of the liver disease rather than hepatic iron concentration is the most impor tant determinant of outcome after liver transplantation and that, in genera l, increasing hepatic iron concentration in cirrhosis is a surrogate marker of the severity of the underlying liver disease.