The natural history of hepatitis C cirrhosis after liver transplantation

• Published in: Liver transplantation Vol. 15; no. 9; pp. 1063 - 1071
• Main Authors: Firpi, Roberto J., Clark, Virginia, Soldevila‐Pico, Consuelo, Morelli, Giuseppe, Cabrera, Roniel, Levy, Cynthia, Machicao, Victor I., Chaoru, Chen, Nelson, David R.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.09.2009
• Subjects: Antiviral Agents - therapeutic use; Disease Progression; Female; Graft Rejection - mortality; Graft Rejection - surgery; Graft Rejection - virology; Hepatitis C - complications; Hepatitis C - drug therapy; Hepatitis C - mortality; Hepatitis C - pathology; Hepatitis C - surgery; Humans; Kaplan-Meier Estimate; Liver - pathology; Liver - surgery; Liver - virology; Liver Cirrhosis - mortality; Liver Cirrhosis - pathology; Liver Cirrhosis - surgery; Liver Cirrhosis - virology; Liver Transplantation - adverse effects; Liver Transplantation - mortality; Male; Middle Aged; Proportional Hazards Models; Recurrence; Reoperation; Retrospective Studies; Risk Assessment; Risk Factors; Severity of Illness Index; Time Factors; Treatment Outcome
• ISSN: 1527-6465; 1527-6473
• DOI: 10.1002/lt.21784

Hepatitis C after liver transplantation leads to graft cirrhosis in up to 30% of patients within 5 years, but limited data exist regarding the clinical course of cirrhosis after transplantation. The aims of this study were to report the natural history of hepatitis C cirrhosis after liver transplantation and to identify risk factors for decompensation and survival. Hepatitis C patients underwent protocol liver biopsies yearly after liver transplantation. After cirrhosis was identified by biopsy, the outcomes of interest were the development of decompensation, death, or retransplantation for hepatitis C. Kaplan‐Meier and Cox regression analysis was used to determine survival and risk factors for decompensation and mortality. Out of 502 liver transplants performed for hepatitis C, 88 patients (18%) had cirrhosis within 3.7 years. Seventy‐one patients were compensated at diagnosis. The cumulative probability of decompensation 1 year after cirrhosis was 30%. A Model for End‐Stage Liver disease score ≥ 16 was predictive of decompensation and poor survival, whereas successful interferon treatment was found to reduce this risk (relative risk = 0.05). Once decompensation occurred, 1‐year survival was 46%. In conclusion, the results confirm an accelerated natural history of hepatitis C cirrhosis after liver transplantation and demonstrate poor survival after decompensation. The Model for End‐Stage Liver Disease can stratify risk for decompensation and survival, whereas successful antiviral therapy may be protective. Liver Transpl 15:1063–1071, 2009. © 2009 AASLD.