Predictive factors for survival and score application in liver retransplantation for hepatitis C recurrence

AIM: To identify risk factors associated with survival in patients retransplanted for hepatitis C virus(HCV) recurrence and to apply a survival score to this population.METHODS: We retrospectively identified 108 patients retransplanted for HCV recurrence in eight European liver transplantation centers(seven in France, one in Spain). Data collection comprised clinical and laboratory variables, including virological and antiviral treatment data. We then analyzed the factors associated with survival in this population. A recently published score that predicts survival in retransplantation in patients with hepatitis C was applied. Because there are currently no uniform recommendations regarding selection of the best candidates for retransplantation in this setting, we also described the clinical characteristics of 164 patients not retransplanted, with F3, F4, or fibrosing cholestatic hepatitis(FCH) post-first graft presenting with hepatic decompensation. RESULTS: Overall retransplantation patient survival rates were 55%, 47%, and 43% at 3, 5, and 10 years, respectively. Patients who were retransplanted for advanced cirrhosis had survival rates of 59%, 52%, and 49% at 3, 5, and 10 years, while those retransplanted for FCH had survival rates of 34%, 29%, and 11%, respectively. Under multivariate analysis, and adjusting for the center effect and the occurrence of FCH, factors associated with better survival after retransplantation were: negative HCV viremia before retransplantation, antiviral therapy after retransplantation, non-genotype 1, a Model for End-stage Liver Disease(MELD) score < 25 when replaced on the waiting list, and a retransplantation donor age < 60 years. Although the numbers were small, in the context of the new antivirals era, we showed that outcomes in patientswho underwent retransplantation with undetectable HCV viremia did not depend on donor age and MELD score. The Andrés score was applied to 102 patients for whom all score variables were available, producing a mean score of 43.4(SD = 6.6). Survival rates after the date of the first decompensation post-first liver transplantation(LT1) in the liver retransplantation(re LT) group(94 patients decompensated) at 3, 5, and 10 years were 62%, 59%, and 51%, respectively, among 78 retransplanted individuals with advanced cirrhosis, and 42%, 32%, and 16% among 16 retransplanted individuals with FCH. In the non-re LT group with hepatic decompensation, survival rates were 27%, 18%, and 9% at 3, 5, and 10 years, respectively(P < 0.0001). Compared with non-retransplanted patients, retransplanted patients were younger at LT1(mean age 48 ± 8 years compared to 53 ± 9 years in the no re LT group, P < 0.0001), less likely to have human immunodeficiency virus(HIV) co-infection(4% vs 14% among no re LT patients, P = 0.005), more likely to have received corticosteroid bolus therapy after LT1(25% in re LT vs 12% in the no re LT group, P = 0.01), and more likely to have presented with sustained virological response(SVR) after the first transplantation(20% in the re LT group vs 7% in the no re LT group, P = 0.028).CONCLUSION: Antiviral therapy before and after retransplantation had a substantial impact on survival in the context of retransplantation for HCV recurrence, and with the new direct-acting antivirals now available, outcomes should be even better in the future.

Changing delta hepatitis patient profile:A single center experience in Valencia region,Spain

BACKGROUND Delta hepatitis is a rare infection with an aggressive disease course.For almost three decades,however,there have been no epidemiological studies in our traditionally endemic area.AIM To investigate the prevalence of delta hepatitis in a sample of patients with chronic hepatitis B virus(HBV)infection followed at a Hepatology Unit in Valencia,Spain.METHODS Retrospective evaluation of anti-hepatitis D virus-immunoglobulin G seroprevalence among patients with chronic HBV infection(n=605)followed at a reference Hepatology Unit in Spain.RESULTS The prevalence of anti-hepatitis D virus-immunoglobulin G among HBV-infected patients was 11.5%:Male(63%)and median age of 52 years.The majority were born in Spain(67%)and primarily infected through intravenous drug use.However,a significant percent(24.5%),particularly those diagnosed in more recent years,were migrants presumably nosocomially infected.Comorbidities such as diabetes(8.5%),obesity/overweight(55%),and alcohol consumption(34%)were frequent.A high proportion of patients developed liver complications such as cirrhosis(77%),liver decompensation(81%),hepatocellular carcinoma(HCC)(16.5%),or required liver transplantation(LT)(59.5%).Diabetes was associated with progression to cirrhosis,LT,and death.Male sex,increasing age,and alcohol were associated with LT and HCC.Compared to HBV mono-infected patients,delta individuals developed cirrhosis and liver decompensation more frequently,with no differences in HCC rates.CONCLUSION Patients infected in the 1980’s were mostly locals infected through intravenous drug use,whereas those diagnosed recently are frequently non-Spanish natives from endemic areas.Regardless of their origin,patients are predominantly male with significant comorbidities,which potentially play a major role in disease progression.We confirm a high rate of subsequent liver complications.