Hepatitis C Infection and Survivals of Liver Transplant Patients in Canada, 1997–2003

Abstract

Introduction Liver transplantation is an important health and health care issue for Canadians. Very few studies have estimated the survival results among liver transplant patients infected with hepatitis C virus (HCV) in Canada. Methods We carried out a retrospective cohort study to analyze 1- to 5-year survival rates among liver transplant patients, using Canadian Organ Replacement Registry data (1997–2003). Patients less than 19 years old were excluded from the study. The patients were categorized according to previous HCV infection status. The HCV-positive and HCV-negative groups were compared in the following characteristics: age group, gender, ethnicity, blood groups, donor type, pretransplantation medical status. Survival curves were plotted by Kaplan-Meier method. Stepwise regression model was applied to control the confounding impact related to gender, age, and HCV infection status. Results A total of 1842 liver transplant patients were included in the analysis. One-year survival rate for all patients was 85.4%. There were 319 HCV-positive recipients in the exposed group and 813 in the HCV-negative group. The HCV-positive and HCV-negative groups were comparable in age groups, ethnicity, ABO blood group, pretransplantation medical status, and donor organ type. The HCV-positive group had the higher male:female ratio (2.32:1) than the HCV-negative recipients (1.49:1) (Mantel Haenszel (MH) χ 2 = 10.0311, P = .0015). There was no significant difference in 1-year survival rate between HCV-positive and HCV-negative groups, but the differences in the 2-year and 5-year survival rates were significant even after adjusting gender factor by stepwise regression analysis (MH χ 2 = 4.4203, P = .0355). Conclusion In Canada, the first-year survival rate is about 85.4%, which is comparable with other industrialized countries. The exaggerated survival disadvantage for HCV-positive recipients seems to be middle and long term, not short term.