Severe recurrent hepatitis C after liver retransplantation for hepatitis C virus–related graft cirrhosis

Abstract

An increase in the number of hepatitis C virus (HCV)-infected transplant recipients at need for repeated liver transplantation is anticipated. To date, there is a certain reluctance to accept these patients because of an increased organ shortage, early reports suggesting a poor outcome, and uncertainty regarding the natural history of recurrent hepatitis C in the second graft. The aim of this study is to determine the outcome of patients undergoing retransplantation for HCV-related graft cirrhosis. Of 49 transplant recipients with HCV-related allograft cirrhosis, 31 patients developed decompensation with criteria for retransplantation. Thirteen patients were denied this option. Of the 18 patients accepted, 6 patients died while on the waiting list (5 patients died of graft cirrhosis at a median of 3.2 months of listing), and 12 patients have undergone retransplantation (median, 10 months since HCV cirrhosis). After retransplantation, 8 patients (67%) died at a median of 8 months, and 4 patients (33%) remain alive after 1.9 years of follow-up. Causes and times of death from retransplantation were: surgical complications, n ‫؍‬ 3 (perioperative period); HCV cirrhosis of the second graft, n ‫؍‬ 2 (at 9 and 54 months); fibrosing cholestatic hepatitis, n ‫؍‬ 1 (at 2 years); lymphoproliferative disorder, n ‫؍‬ 1 (at 7 months); and endocarditis, n ‫؍‬ 1 (at 3.5 years, with underlying cirrhosis). Of the 4 patients alive, fibrosis stages in the last biopsy specimens are stage 1 (n ‫؍‬ 1), stage 3 (n ‫؍‬ 1), and stage 4 or cirrhosis (n ‫؍‬ 1; one patient has not undergone biopsy), despite antiviral therapy. The outcome of retransplantation for HCV cirrhosis of the first graft is very poor because of multiple complications. The severity of recurrent HCV disease in the second graft seems to be related to that observed in the first graft. (Liver Transpl 2003;9:228-235.)

Glucocorticosteroids Increase Cell Entry by Hepatitis C Virus

“…Notably, the outcome of hepatitis C after liver transplantation has worsened during the last 10-15 years 4 . Several factors have been suspected to be accountable including an increased donor age 5 .…”

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“…Rapid fibrosers were defined as patients who developed grade 2 or more Ishak grade fibrosis within 1 year after liver transplant. 6 The HAI according to the Ishak score also was noted. We defined posttransplant Ishak score ≥ 6 as significant for HCV recurrence.…”

“…The course of graft hepatitis usually is more progressive than that of primary HCV infection. [4][5][6][7] Histologic recurrence is observed in > 50% HCVinfected grafts within the first year and is responsible for allograft failure in 10% recipients within 5 years of transplant. 8 A few studies have evaluated the effect of posttransplant histologic recurrence of HCV on HCC recurrence and survival rates.…”

Managing hepatitis C in liver transplant patients with recurrent infection

“…The prognosis for these patients is poor in comparison with the first transplantation. [153][154][155][156][157][158][159][160] Many patients are not considered eligible for retransplantation and die from recurrent disease and its complications, but there are no recommendations or guidelines about retransplantation in these patients. The option of retransplantation is discussed on an individual base.…”