Korean J Hepatol.  2007 Dec;13(4):543-555. 10.3350/kjhep.2007.13.4.543.

Clinical Outcome after Living Donor Liver Transplantation in Patients with Hepatitis C Virus-associated Cirrhosis

• Park JI
• Choi KM
• Lee SG
• Hwang S
• Kim KH
• Ahn CS
• Moon DB
• Chung YH
• Lee YS
• Suh DJ

• KMID: 1776830
• DOI: http://doi.org/10.3350/kjhep.2007.13.4.543

Abstract

BACKGROUND AND AIMS: Hepatitis C virus (HCV)-associated cirrhosis is an increasingly frequent indication for liver transplantation (LT). However, HCV recurrence is universal and this immediately occurs following LT, which endangers both the graft and patient survival. We investigated the frequency of posttransplant recurrence of HCV infection and the patient-graft survival, and we analyzed the responses to ribavirin and interferon therapy in the patients with recurrent HCV infection after living donor liver transplantation (LDLT). METHODS: We retrospectively reviewed the clinical outcomes of 39 HCV-associated cirrhosis patients who underwent LDLT at Asan Medical Center between August 1992 and June 2006. In this study, the diagnosis of recurrent HCV was made on the basis of increased transaminases and serum HCV RNA levels greater than 10 million IU/mL because protocol liver biopsy was not performed. RESULTS: HCV recurrence was seen in 26 of the 39 LDLT patients (66.7%). 86.7% of recurrence occurred within the first postoperative year. Antiviral treatment was used for all patients with recurrence of HCV. None of the 10 patients receiving ribavirin alone and 9 of 16 patients who received combination therapy with pegylated interferon alpha-2a plus ribavirin became HCV RNA negative and they remained persistently negative during the median follow-up of 24.9 months. Our data indicates that there is no significant factor influencing HCV recurrence except for the recipient's age. The 2-year patient survival for the HCV patients with HCC and those patients without HCC were 81.2% and 81.3%, respectively (P=0.85) and the 2-year graft survival rates were 81.2% and 68.2%, respectively (P=0.29). No patient died from HCV recurrence during the follow-up period. CONCLUSIONS: Combination therapy with ribavirin and interferon appears to improve the outcome of recurrent HCV infected patients after LDLT.

Keyword

Hepatitis C virus; Liver transplantation; Recurrence; Treatment; Treatment outcome

MeSH Terms

Adult
Aged
Antiviral Agents/therapeutic use
Combined Modality Therapy
Female
Graft Survival
Hepacivirus/drug effects/isolation & purification
Hepatitis C, Chronic/complications/diagnosis/*drug therapy
Humans
Interferon Alfa-2a/therapeutic use
Liver Cirrhosis/mortality/*surgery/*virology
Liver Neoplasms/mortality
*Liver Transplantation
Living Donors
Male
Middle Aged
Polyethylene Glycols/therapeutic use
Recurrence
Retrospective Studies
Ribavirin/therapeutic use
Severity of Illness Index
Treatment Outcome