Survival Analysis of Liver Transplant Patients with HCV Infection in Canada 1997–2002

Abstract

Liver transplantation is an important health care issue for Canadians. Very few studies have assessed survival and determinants of survival in liver transplant patients in Canada. We carried out an epidemiological analysis of 1 year survival in liver transplant patients, using Canadian Organ Replacement Registry data (1997–2003). Survival curves were plotted by the Kaplan-Meier methods. Cox proportional hazard analysis was applied to evaluate the hazard ratios for different age groups, gender, ethnicity, blood groups, donor type, pre-transplantation medical status, and HCV infection status. A total of 2058 liver transplant patients were included in the analysis. The main indication for liver transplantation was chronic hepatitis C (23.13%), followed by alcoholic cirrhosis (13.12%). HCV infected patients (n=320) had significantly lower survival probability than HCV negative patients (n=929) with 1-year survival rates of 75% and 85% respectively. In comparison with Caucasians, the Aboriginals had 9% lower survival probability whereas Pacific Islands had 32% higher survival probability. Live organ recipients (n=117) had 73% higher survival probability than cadaveric organ recipients (n=1,945) with in-family receipts having higher survival probability than patients receiving organs from unrelated donors. Pre-transplantation medical statuses also had significant influences on the survival rates of the patients with tumor or fulminant hepatitis, ICU-intubated /ventilated patients, hospitalized patients at ICU units, hospitalized patients and patients at home. Chronic hepatitis C virus infection was a main indication for liver transplantation in Canada. Types of organ donor, genetic similarities between donors and recipients, ethnicity and pre-transplantation medical status of the recipients played important roles for the survival probability status of the recipients.