J Korean Soc Transplant.  2016 Dec;30(4):155-164. 10.4285/jkstn.2016.30.4.155.

Outcomes for Patients with Hepatitis C Virus after Liver Transplantation in Korea

• Kim JM

• KMID: 2364935
• DOI: http://doi.org/10.4285/jkstn.2016.30.4.155

Abstract

Hepatitis C virus (HCV)-related liver disease is the most common indication for liver transplantation (LT) in Western countries, whereas HCV LT is rare in Korea. We conducted a survey of HCV RNA-positive patients who underwent LT and investigated the prognostic factors for patient survival and the effects of immunosuppression. To accomplish this, we retrospectively reviewed the multicenter records of 192 HCV RNA-positive patients who underwent LT. The 1-, 3-, and 5-year overall survival rates were 78.8%, 75.3%, and 73.1%, respectively. Excluding cases of hospital mortality (n=23), 169 patients were evaluated. Most patients were genotype 1 (n=111, 65.7%) or genotype 2 (n=42, 24.9%). The proportion of living donors for LT (n=135, 79.9%) was higher than that of deceased donors (DDLT; n=34, 20.1%). The median donor and recipient ages were 32 and 56 years, respectively. Twenty-eight patients (16.6%) died during the observation period, while 75 underwent universal prophylaxis and 15 received preemptive therapy. HCV recurrence was detected in 97 patients. Recipients who were older than 60, received DDLT, used cyclosporine, or suffered acute rejection had lower rates of survival. Acute rejection was closely associated with a lack of induction therapy, cyclosporine use, and universal prophylaxis after transplantation. The careful avoidance of acute rejection in the post-transplant period through adequate use of tacrolimus is a preferable strategy that increases patient survival following liver transplantation.

Keyword

Hepacivirus; Hepatitis C; Immunosuppression; Tacrolimus; Graft rejection; Survival; Antiviral agents

MeSH Terms

Antiviral Agents
Cyclosporine
Genotype
Graft Rejection
Hepacivirus*
Hepatitis C*
Hepatitis*
Hospital Mortality
Humans
Immunosuppression
Korea*
Liver Diseases
Liver Transplantation*
Liver*
Living Donors
Recurrence
Retrospective Studies
Survival Rate
Tacrolimus
Tissue Donors
Antiviral Agents
Cyclosporine
Tacrolimus

Figure

• 

  Fig. 1. Patient survival rates. The 1-, 3-, and 5-year patient survival rates are 78.8%, 75.3%, and 73.1%, respectively.

• 

  Fig. 2. Patient survival according to recipient age, donor type, calcineurin inhibitor, and biopsy-proven acute rejection. Abbreviations: LDLT, living donor liver transplantation; DDLT, deceased donor liver transplantation; BPAR, biopsy-proven acute rejection.

• 

  Fig. 3. Patient survival according to SVR. Patient survival in patients with SVR was higher than in patients without SVR, but there was no statistically significant difference in patient survival between the two groups. Abbreviations: SVR, sustained viral response.

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