HIGHER PRETRANSPLANT HCV RNA LEVELS ASSOCIATED WITH POOR PATIENT AND GRAFT SURVIVAL

Abstract

643 Background. End-stage liver disease secondary to hepatitis C virus (HCV) infection is the leading indication for orthotopic liver transplantation in the United States. Recurrence of HCV infection is nearly universal. We studied the patients enrolled in the National Institute of Diabetes and Digestive and Kidney Diseases Liver Transplantation Database to determine whether pretransplant patient or donor variables could identify a subset of HCV-infected recipients with poor patient and/or graft survival.Methods. Between April 15th, 1990 and June 30th 1994, 166 HCV-infected patients and 509 patients who were HCV-negative underwent liver transplantation at the participating institutions. Median follow-up was 5.0 years for HCV-infected recipients, and 5.2 years for HCV-negative controls. Pretransplant donor and recipient characteristics, patient and graft survival were prospectively collected and compared.Results. Cumulative one and five year patient survival for HCV-infected (91% and 76% respectively) and HCV-negative recipients (89% and 77% respectively, p=NS) were similar. Pretransplant factors independently associated with increased cumulative mortality or graft loss and their relative risk among 166 HCV-infected recipients were:Table Recipients who had a pretransplant HCV RNA titer of ≥1 × 106 vEq/ml had a cumulative five year survival of 57%, vs. 84% for those with HCV RNA titers of <1 × 106 vEq/ml (p=0.0001). Patient and graft survival did not vary with recipient gender, HCV genotype or induction immunosuppression regimen among the HCV-infected recipients. Conclusions. While long-term patient and graft survival following liver transplantation for end-stage liver disease secondary to HCV are generally comparable to that of most other indications, pretransplant HCV RNA titers of ≥1 × 106 vEq/ml and non-Caucasian recipient race are associated with poor survival among HCV-infected patients undergoing liver transplantation. Major efforts at prevention and treatment of hepatitis C after transplantation might be directed at those recipients with high initial levels of HCV RNA.