Survival Rate Lower for HCV Patients After Liver Transplantation

Liver transplant recipients with hepatitis C virus (HCV) are at a risk of complications and have an overall survival rate lower than those without HCV infections, according to new research.

A team, led by Masatoshi Ishigami, Department of Gastroenterology and Hepatology, Nagoya University School of Medicine, reviewed why there is often a poor prognosis following liver transplantation for patients with hepatitis C virus, whose main causes of death were generally due to recurrent disease.

“HCV recurrence after liver transplant is a universally understood complication,” the authors wrote. “Once the new graft is reinfected with HCV, a rapid increase of virus is induced, resulting in a high proportion of patients developing recurrent hepatitis, with 20% to 40% of patients progressing to liver cirrhosis in 5 years and half of patients subsequently showing decompensation after several years.”

Comparing HCV Patients

The investigators identified 132 adult patients who underwent liver transplantation due to liver cirrhosis between April 2003 and March 2017. Of this group, 30.3% (n = 40) were positive for HCV. Each patient was diagnosed with end-stage chronic liver disease.

The mean age of recipients was 49.8 ± 11.0 years and the mean age of donors was 38.0 ± 13.1 years. In addition, 49 patients had hepatocellular carcinoma (HCC), 111 patients received living donor liver transplants, and the remaining 21 patients received deceased donor liver transplants.

The investigators used the Kaplan-Meier method to identify the survival rate following the procedure and used log-rank tests to compare survival among subgroups. They also performed propensity score matching to compare between HCV=positive and HCV-negative patients.

The team compared the overall survival following the transplantation for both groups of patients, as well as the cause of death for liver recipients with HCV.

Survival Rates

The overall survival of patients with hepatitis C virus infections was 82.2% at year 1, 75.2% at year 5, and 50.8% at year 10 following the transplant (P = .001).

The overall survival rates were lower comparatively to the group of patients with HCV. For this group, the survival rate was 94.5%, 87%, and 87% at years 1, 5, and 10 respectively.

In addition, 14 patients in HCV group died following the liver transplant with 3 of the deaths caused by hepatocellular carcinoma recurrence.

On the other hand, only 1 patient died from an HCV-related complication—fibrosing cholestatic hepatitis. The remaining 10 patients died from other reason outside of HCV disease progression.

Survival varied significantly based on the reason for transplant (P = .017), with survival significantly lower in HCV-positive patients compared to patients with hepatitis B virus (P = .037), primary biliary cholangitis (P = .026), and primary sclerosing cholangitis (P = .026).

“In our investigation of outcomes of HCV-positive patients who underwent liver transplant, HCV-positive patients definitely showed poorer prognosis after liver transplant compared with transplant recipients who were negative for HCV,” the authors wrote. “However, most deaths were not related to liver disease in our cohort. Therefore, both progression of liver diseases and extrahepatic manifestations should be carefully monitored in HCV-positive transplant patients.”

The study, “Revisiting Prognosis After Liver Transplant in Patients Positive for Hepatitis C Virus: Focus on Hepatitis C Recurrence-Unrelated Complications,” was published online in Experimental and Clinical Transplantation.