Liver Transplantation for Hepatitis C: Recurrence and Disease Progression in 300 Patients

Testa, Giuliano; Crippin, Jeffrey S.; Netto, George J.; Goldstein, Robert M.; Jennings, Linda W.; Brkic, Borisa S.; Brooks, Barbara K.; Levy, Marlon F.; Gonwa, Thomas A.; Klintmalm, Göran B.

doi:10.1053/jlts.2000.9741

Cited by 179 publications

(138 citation statements)

References 23 publications

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“…The length of stay was about 1 week longer at reTX (second transplant, median days Ϯ standard deviation, 13 Ϯ 4 vs. 19 Ϯ 3 ). Interestingly, ICU days were similar among groups and transplants (first transplant, median days, 2 Ϯ 0.5 vs. 3 Ϯ 0.5 [1][2][3][4][5][6][7][8][9][10]; second transplant, median days 3 Ϯ 2 [1-70] in both groups). In group 1, 21 (49%) patients were hospitalized at the time of reTX and 4 (9%) were in the ICU.…”

Section: Days Of Hospitalization and Intensive Care Unit (Icu)mentioning

confidence: 99%

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Retransplantation for hepatitis C: Results of a U.S. multicenter retransplant study

et al. 2007

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It is widely perceived that outcomes are relatively poor following retransplantation (reTX) for recurrent of hepatitis C virus (HCV) infection. Transplant centers debate the utility of offering another liver to these patients. A U.S. study group was formed to retrospectively compare survival after reTX in patients with recurrent HCV (histologically proven) and those transplanted for other indications greater than 90 days after first transplantation, from 1996 to 2004. Patients were divided into 3 groups; group 1: HCV reTX (n ϭ 43), group 2: non-HCV reTX (n ϭ 73), and group 3: recurrent HCV but no reTX (n ϭ 156). They were predominantly male, Caucasian, with mean age of 47.2 yr. The commonest indications for non-HCV reTX were chronic rejection (36%), hepatic artery thrombosis (31%) and recurrent primary sclerosing cholangitis (17%). Duration of hospitalization, number of intensive care unit (ICU) days, and time interval from listing to transplantation or reTX were similar between reTX groups. The 1-yr and 3-yr survival rates after reTX were also similar for HCV reTX and non-HCV reTX groups (1 yr, 69% vs. 73%; 3 yr, 49% vs. 55%). Model for End-Stage Liver Disease (MELD) scores were not predictive of survival from reTX. However, with a MELD score of Ͼ30 in the non HCV group, survival was Ͻ50%. In the recurrent HCV not undergoing reTX group, 30% were reevaluated for reTX but only 15% were listed for reTX and the 3-yr survival was 47%. The most common reasons for not listing for reTX were recurrent HCV within 6 months (22%), fibrosing cholestatic hepatitis (19%), and renal dysfunction (9%). In conclusion, patients retransplanted for recurrent HCV had similar 1-yr and 3-yr survival when compared to patients undergoing reTX for other indications. MELD scores were not predictive of post-reTX survival. Survival was Ͻ50% in the non-HCV reTx group with MELD score of Ͼ30. Many patients with recurrent HCV are not considered for reTX and die from recurrent disease.

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Section: Days Of Hospitalization and Intensive Care Unit (Icu)mentioning

confidence: 99%

“…1,2 Efficacy of treatment of the recurrent HCV is limited by many factors, including drug toxicity and immunosuppression, with sustained virological response rates in the range of 30%. 3,4 The progression to graft failure is significant and liver transplant centers are debating the issue of retransplantation (reTX).…”

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confidence: 99%

Retransplantation for hepatitis C: Results of a U.S. multicenter retransplant study

et al. 2007

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“…1,2 HCV recurrence is apparent histologically in 40 to 60% of liver transplant recipients within the 1st postoperative year, 3,4 and may lead to cirrhosis of the graft in as many as 30% of the recipients within 4 to 5 years. 5,6 The clinical presentation of RHC is nonspecific and usually consists of elevated aminotransferases and vague symptoms.…”

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confidence: 99%

Reliability of histopathologic assessment for the differentiation of recurrent hepatitis C from acute rejection after liver transplantation

et al. 2004

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Histopathologic assessment is considered essential for the differentiation of recurrent hepatitis C (RHC) from acute cellular rejection (ACR) after liver transplantation (LT); however, there is limited information regarding its reliability. The aim of this study was to determine the interobserver and intraobserver agreement of the histopathologic diagnosis of RHC vs. ACR, and to determine the reliability of specific histopathologic features for the differentiation of RHC from ACR. Liver biopsy specimens from 105 consecutive patients transplanted for hepatitis C virus (HCV)-related liver disease were studied retrospectively. All the biopsies were performed for evaluation of abnormal liver enzymes within the 1st year after LT. The slides were blindly coded and assessed by 5 liver-transplant pathologists, practicing at 3 medical centers. The pathologists were asked to render a diagnosis, and determine the severity of the disease. Four of the pathologists were asked to determine the presence and severity of 36 histopathologic features. A total of 34 of the samples were then blindly resubmitted to each of the 4 pathologists to determine the intraobserver agreement. There was a slight agreement ( ‫؍‬ .12) among the 5 pathologists on the histopathologic diagnosis. All 5 pathologists were in agreement on the diagnosis of RHC in only 5 patients (5%) and on the diagnosis of ACR in only 2 patients (2%). The best agreement among any 4 pathologists was fair ( ‫؍‬ .20). Slight to moderate agreement occurred on the main histological features considered to be important in the diagnosis of ACR. Intraobserver agreement ranged from slight ( ‫؍‬ .19) to moderate ( ‫؍‬ .42) among 4 pathologists. In conclusion, the histopathologic differentiation of RHC from ACR after LT had relatively low interobserver and intraobserver agreement rates, and hence showed low reliability. Histopathologic assessment should be used cautiously for the differentiation of RHC from ACR post-LT. (Liver

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“…More severe baseline histology and significant elevation of liver enzyme values are associated with a shortened duration of graft and patient survival [14] (Fig. 1).…”

Section: Factors Influencing Recurrent Hcv Infectionmentioning

confidence: 99%

Treatment of recurrent hepatitis C virus infection in patients after liver transplantation

Lengyel¹,

Tulassay²

2009

Clinical and Experimental Medical Journal

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The main indication for liver transplantation is the final stage of hepatic cirrhosis developed due to hepatitis C virus (HCV) infection. The recurrence of HCV infection after transplantation is a common situation. Recurrent hepatitis C is a progressive disease; in 20% of patients it produces liver cirrhosis without treatment beside immunosuppression within 5 years. Treatment of recurrent HCV infection is the most important factor of survival in patients with transplantation. Based on literary data and their observations, the authors review the factors influencing the progression of recurrent HCV infection. They discuss in details the effect of immunosuppressive therapy, the importance of selecting appropriate immunosuppressive drugs. They review the key points in the diagnosis of recurrent hepatitis C; underline the decisive role of liver biopsy carried out according to protocol in the diagnosis, as well as the hard consultation between specialists of pathology, hepatology and surgery. They demonstrate their observations with the treatment of patients on the waiting list, the results of early pre-emptive treatment of recurrent chronic hepatitis, furthermore treatment modalities and results in patients with histologically proven chronic hepatitis C. The drug of choice for chronic hepatitis C after transplantation is combined therapy with pegylated interferon and ribavirin. This therapy is able to assure sustained virological negativity in 20-50% of patients. In virus-free patients the inflammatory activity in the liver significantly decreases, and the histologic activity index improves. There are data showing a fibrosis-inhibiting effect of the treatment, however, multicentric studies are required for their confirmation. No advantage of early antiviral treatment without histologic alteration has been confirmed by most of the trials. In this group of patients common side effects of the treatment include anaemia and neutropenia, and therefore administration of erythropoietin and granulocyte stimulating factor is recommended. Further research and clinical studies are required in order to establish optimal treatment of patients with recurrent hepatitis C, to determine the dosage of pegylated interferon and ribavirin, to decrease duration of therapy, to reduce side effects and finally to achieve the healing phase in a greater percentage of patients.

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Liver Transplantation for Hepatitis C: Recurrence and Disease Progression in 300 Patients

Cited by 179 publications

References 23 publications

Retransplantation for hepatitis C: Results of a U.S. multicenter retransplant study

Retransplantation for hepatitis C: Results of a U.S. multicenter retransplant study

Reliability of histopathologic assessment for the differentiation of recurrent hepatitis C from acute rejection after liver transplantation

Treatment of recurrent hepatitis C virus infection in patients after liver transplantation

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