Liver transplantation for chronic C hepatitis, significance for antivirus treatments

Abstract

Chronic hepatitis C nowadays represents the most common indication for liver transplantation (LTx) worldwide. The survival rate of HCV patients after LTx is worse than that of patients transplanted for cirrhosis of other aetiology owing to HCV graft reinfection leading to the development of recurrent hepatitis C in the liver graft. We retrospectively reviewed 149 patients, 50 females and 99 males, who underwent LTx in the period from 1995 to 2013 of a total of 957 liver graft recipients who underwent LTx within the same period (HCV represents 15.6% of all LTx indications). The average age of the patients was 53 (ranging from 15 to 69). One hundred and forty-eight patients were infected with genotype lb, only one patient had genotype 3a. Forty-eight patients had a small hepatocellular carcinoma. Eighty-two patients of 149 were given antiviral treatment. The survival of HCV patients was worse compared to the group of patients with non-HCV cirrhosis as well as of all other patients; three years 79.3%, five years 72.5% and 10 years 62.9% (non-HCV cirrhosis 89.4%, 87.2% and 79.7%; p < 0.001, all other patients 88.2%, 85.8% and 78.8 %; p < 0.001). Thirty-two of 82 patients achieved a sustained virological response (SVR) after administration of a combined antiviral therapy (39%). The survival of patients who achieved an SVR (100%, 92.0% and 92.0%) was significantly better than the survival of patients without SVR (85.7%, 76.9% and 63.3%; p = 0.0026), the worst was the survival of patients who were not treated due to a contraindication to therapy (63.1%, 58.3% and 47.0%, p < 0.001). Eradication of the HCV infection and SVR significantly increased the survival of patients transplanted for HCV infection butthe number of patients, who are not eligible for peginterferon a-based therapy, still remains high.