Liver transplantation and hepatitis C virus. Results in a Spanish center since 1989

Background/Aims: Hepatitis C-related liver disease is the main indication f or liver transplantation in many centers. Viral RNA remains after transplan tation in almost 100% of the patients, and more recent reports show a graft hepatitis rate of about 90%. The progression of this hepatitis seems to be quicker than in the nontransplant setting. Methodology: From June 1989 to October 2000, 197 adult patients had 213 for HCV-related liver disease at our institution. Basal immunosuppression cons isted of a triple therapy with cyclosporine, azathioprine and steroids, or dual therapy with tacrolimus and steroids. None of the patients was treated with antivirals after liver transplantation. Results: Pure HCV-related cirrhosis was the indication for liver transplant ation in 114 patients, another 14 with hepatocellular carcinoma, 8 associat ed metabolic diseases, 43 high alcohol intake, 4 hepatitis B, 5 cholestatic diseases, and 3 other diseases. Six patients out of the 197 transplanted i n this period were already grafted before this tune, and had their first re transplantation of the liver after 1989 (their first liver transplantation was done when HCV was not known). Sixteen additional retransplantation proc edures were done in the period considered. Hepatitis was diagnosed in 84.3% of the grafts biopsied later than 90 days after liver transplantation (118 /140), and in 92.9% if it was done after one year (92/99). Cirrhosis was di agnosed in 21 grafts at a mean time of 1004.7 days, 21.2% of the grafts bio psied after 1 year and 28.6% after 2 years. Nine grafts in 8 patients were diagnosed as fibrosing cholestatic hepatitis. Patient actuarial survival was 80.9%, 69.7%, 67.5% and 50.6% at 1, 3, 5 and 10 years. Liver failure and hepatoma recurrence were the cause of death in 42.4% of the patients. Actuarial graft survival was 75.2%, 64.9%, 63.5% an d 48.6% at 1, 3, 5 and 10 years, and was significantly affected by Child st age (Bus. C, P = 0.004). When compared to 228 non-HCV-infected patients wit h chronic parenchymatous disease, these had an almost significantly better patient survival (P = 0.0577), but a nonsignificant difference in graft sur vival. Graft loss related to liver causes was 17.6% in HCV+ patients 14.6% in HCV-patients. Liver causes of death were 14.0% in HCV+ patients and 4.8% in HCV-patients (P = 0.002). Conclusions: HCV infected liver transplantation recipients present very oft en graft hepatitis, which may progress to advanced stages in a quite short interval. Mid-term patient and graft survival is comparable to those of non -HCV recipients, but causes of death related directly to Ever disease are m ore common in HCV+. This makes one think that long-term prognosis (more tha n 10 or 15 years) will be worse in HCV patients.