DR ANTIGENS INFLUENCE GRAFT OUTCOME AND HCV RECURRENCE AFTER LIVER TRANSPLANTATION

Abstract

O374 Aims: Hepatitis C (HCV) recurrence following liver transplantation is universal. We speculated that recipient DR antigens or the level of DR mismatching between recipient and donor may affect allograft survival and the severity of HCV recurrence. Methods: DR antigens were determined by SSP in 420 HCV negative deceased donors and their corresponding allograft recipients. HCV diagnosis was based upon liver histology. All HCV+ allograft recipients underwent posttransplant liver biopsies. Biopsies were scored using the Knodell system. Results: Actuarial 10 yr allograft survival was poorer in HCV+ recipients than HCV- recipients (45.8% vs. 61.7%, p<.001). HCV+ vs. HCV- recipients showed different frequencies of DR2 (10.9% vs. 17.9%, p=.007), DR3 (18.9% vs. 9.8%, p=.0002) and DR5 (5.9% vs. 11.3%, p=.007). In contrast, remaining DR frequencies were equivalent (p=ns). Therefore, clinical outcome of HCV+ recipients with DR2, DR3 or DR5 was compared to all other DR’s (OTHER). Recipients with DR3 had reduced allograft survival (48% vs. 62%, p<.02), a higher rate of retransplantation (46% vs. 21%, p<.05), a higher rate of HCV recurrence at l year (81% vs. 68%, p<.05) and more severe disease (p<.05) than OTHERS. In contrast, recipients with DR5 had equivalent allograft survival (58% vs. 62%, p=ns) but with a lower rate of retransplantation (8% vs. 21%, p<.05), a lower rate of HCV recurrence at l yr (36% vs. 68%, p<.05) and developed a more benign liver disease (p<.05) than OTHERS. Outcome variables for recipients with DR2 were equivalent to OTHERS (p=ns). The incidence of acute rejection was equivalent (p=ns) in all groups. The level of 0. 1 and 2 DR mismatches between recipient and donor did not (p=ns) affect HCV recurrence or severity. However, allograft survival (75% vs. 46%, p<.05) and incidence of retransplantation (0 vs. 26%, p<.05) was better in the 0 mismatched patients than the other groups. Conclusions: The frequency of DR2, 3 and 5 antigens differs among HCV+ vs. HCV- liver transplant recipients. HCV recurrence and clinical outcome is more severe among DR3 recipients. In contrast, HCV+ patients with DR5 have a more benign clinical outcome. In addition, HCV+ recipients who share both DR antigens with the donor show better allograft outcome although HCV recurrence is unaffected. The data show that host genetic factors play a significant role in HCV recurrence and allograft outcome after liver transplantation.