The Impact of Hepatitis C Virus on Biliary and Vascular Complications Post-orthotopic Liver Transplantation

Abstract

Introduction: Despite advances in orthotopic liver transplantation (OLT) complications arising from biliary anastomosis have been reported as high as 30 to 40%. Hepatitis C (HCV) and biliary complications are among the major causes of graft loss and morbidity in OLT. We set out to determine whether HCV increases biliary and vascular complications post-OLT. Methods: We performed a retrospective review of 273 patients that underwent OLT at our institution from 1/2012 - 4/2015, comparing patients with and without HCV. Data collected included patient demographics, hepatitis status, reason for transplantation, imaging, procedure performed, and biliary complications. T-test and logistic regression assessed the association between dependent and independent variables. For continuous data, the results were summarized as mean difference (MD) and standard deviation (SD), and for dichotomous data as odds ratio (OR) and 95% confidence intervals (CI). Results: The mean age of the HCV group was 58.3 ± 5.83 years versus 54.2 ± 11.5 years for the non-HCV group; p= < 0.0001. The majority were males with 100 (88.5%) in the HCV and 102 (63.7%) in the non-HCV group; p= < 0.0001. Despite the HCV group requiring more ERCPs (30.9% vs 23.1%) this did not reach statistical significance.A higher percentage of bile leaks were seen in non-HVC patients (8.1%vs.1.8%; p=0.04). Overall, more anastomotic and non-anastomotic strictures were seen in the HCV group, and more vascular complications and hepatic artery stenosis were seen in non-HCV patients, but none reached statistical significance.When looking at HCV viral loads pre- and post- transplant (>700K vs 700K) there was no difference in biliary or vascular complications post-liver transplant. Furthermore, genotype did not appear to play a role in increasing the odds of having vascular or biliary complications. Conclusion: In our population HCV did not appear to increase the chance of biliary or vascular complications. When performing a subset analysis on both increased viral load before or after transplant, as well as the role of genotype there does not to be a statistically significant difference between these groups Larger prospective trials should be performed to confirm these findings.Figure 1Figure 2