Graft and Patient Survival After Liver Transplantation of Patients With Cirrhosis Due to Alcohol and Hepatitis C: Comparison to Alcoholic Cirrhosis and Hepatitis C Cirrhosis

Abstract

Background and Aim: Graft and patient survival after liver transplantation (LT) is poor for hepatitis C virus (HCV) cirrhosis compared to alcoholic cirrhosis (AC). Data on outcome after LT for cirrhotics due to HCV and alcohol are limited. We compared post LT course of patients transplanted for HCV cirrhosis, alcoholic cirrhosis, and cirrhosis due to alcohol and HCV. Methods and Results: United Network for Organ Sharing data (1991-2010) was used to select study population of adult cirrhotics who have undergone first LT for either HCV cirrhosis (group I), alcoholic cirrhosis (group II) or cirrhosis due to alcohol and HCV (group III). Kaplan Meier survival estimates compared graft and patient survival. Results: Of 88368 LT, 19125 (23%), 9926 (12%), 4869 (5%) were performed for group I, II, and III respectively. Three groups were different for recipient (age, gender, race, MELD score, CMV status, and warm ischemia time) and donor (age, gender, race, heart beating status, infection, CMV +ve, HCV +ve, and donor risk index) characteristics. Proportion of recipients on ventilator, on dialysis, being diabetic, with TIPS, having simultaneous kidney transplant, with previous abdominal surgery, with history of portal vein thrombosis, and with HCC were also different across the groups. Five year graft and patient survival for group III were similar to group I (63% vs. 64%; P=0.33 and 69% vs. 70%; P=0.67 respectively) and worse than group II (63% vs. 69%; P<0.0001 and 69% vs. 73%; P=0.0003 respectively). On Cox proportional hazard regression analysis, group was an independent predictor for graft and patient survival after adjusting for recipient and donor characteristics. Graft survival for group III was similar to group I (HR 1.03 [0.97-1.09]) and worse than group II (1.27 [1.191.35]). Patient survival for group III was worse than group I (HR 1.09 [1.02-1.15]) and group II (HR1.27 [1.19-1.36]). Proportion of deaths in groups I, II, and III due to denovo tumors were 10% vs. 15% vs. 11% respectively (group III vs. I; P=0.09 and group III vs. II; P=0.004) and due to metabolic complications were 11% vs. 17% vs. 13% respectively (group III vs. I; P=0.19 and group III vs. II; P=0.001). Proportion of graft loss due to recurrent hepatitis in groups I, II, and III were 41% vs. 7% vs. 36% respectively (group III vs. I; P=0.014 and group III vs. II; P<0.0001). Conclusions: Graft survival of patients undergoing LT for cirrhosis secondary to HCV and alcohol is similar to patients with HCV cirrhosis and worse than AC. Patient survival after LT for patients with cirrhosis due to alcohol and HCV is worse compared to AC and HCV cirrhosis. Strategies to improve antiHCV regimens, screening for tumors, and manage metabolic problems are needed for patients undergoing LT for cirrhosis due to alcohol and HCV.