Retransplantation in patients with hepatitis C recurrence after liver transplantation

José A. Carrión, Miquel Navasa, Xavier Forns

Received 10 November 2009; received in revised form 8 June 2010; accepted 10 June 2010. published online 30 July 2010.

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HCV-infection recurs universally after liver transplantation (LT) and fibrosis progression is accelerated in the graft. Retransplantation (RT) is the only therapeutic option to achieve long-term survival in patients with decompensated cirrhosis after LT. Patient and graft survival rates after RT are inferior to those after primary LT. It is generally accepted that severe hepatitis C recurrence (cholestatic hepatitis) and forms with rapid fibrosis progression have a poor survival after RT. However, it is not clear whether rapid fibrosis progression in the first graft will be followed by the same rate of fibrosis progression in the second graft. The use of prognostic scores as screening tools has shown an improvement in survival in HCV-infected patients after RT, reaching similar survival rates as those obtained in non HCV-infected patients. Moreover, these scores can identify candidates with a high risk of mortality in whom the use of a new organ would be unreasonable. Prevention of severe hepatitis C recurrence could be the first step to avoid RT. Thus, antiviral treatment on the waiting list (if possible) and early identification and treatment of patients with severe hepatitis C recurrence may be a good strategy to avoid RT. In addition, active management of factors which can accelerate fibrosis progression (donor age, post-transplant diabetes, high dose of corticosteroids) might reduce the incidence of severe forms of hepatitis C recurrence.

Abbreviations: RT, retransplantation, LT, liver transplantation, HCV, hepatitis C virus, PNF, primary non-function, HAT, hepatic artery thrombosis, UNOS, United Network for Organ Sharing, MELD, model for end-stage liver disease, ECD, extender criteria donors, HCC, hepatocellular carcinoma, SVR, sustained virological response

Keywords: Severe recurrence, Cirrhosis, MELD, Survival

Liver Unit, Institut de Malalties Digestives, Hospital Clínic, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Barcelona, Spain

Corresponding author. Address: Liver Unit, Escala 7, 3 pis., Villarroel 170, Hospital Clinic, Barcelona 08036, Spain. Tel.: +34 93 227 54 99; fax: +34 93 451 55 22.

PII: S0168-8278(10)00623-9

doi:10.1016/j.jhep.2010.06.006

© 2010 Published by Elsevier Inc.

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