Hepatitis C infection in patients undergoing liver retransplantation

Background. There is concern that repeat orthotopic liver transplantation in patients with hepatitis C virus (HCV) infection may be associated with poor long-term survival. The specific aims of the current analysis were to determine (1) the prevalence of HCV infection in a large cohort of patients undergoing retransplantation, (2) define the impact of HCV infection on patient survival, and (3) determine the predictors of outcome of HCV-positive patients undergoing retransplantation for graft failure not caused by primary nonfunction. Methods. We analyzed the United Network of Organ Sharing (UNOS) registry data of 1539 adults undergoing orthotopic liver retransplantation between January 1990 and February 1996; 357 patients (23%) were HCV-positive. Results. The prevalence of HCV infection increased significantly from 6.5% in 1990 to 38.4% in 1995 (P<0.0001). Comparing the HCV-positive versus HCV-negative groups, there were no significant differences with regards to age, time to retransplantation, biochemical parameters immediately preceding retransplantation, UNOS registry status mix, or cause of graft failure (% with primary nonfunction). However, Kaplan-Meier analysis demonstrated significantly diminished survival in the HCV-positive group (P=0.0038, log-rank test; relative risk, 1.36; 95% confidence interval: 1.07-1.71). Multivariate logistic regression analysis of the subgroup of HCV-positive patients undergoing retransplantation for graft failure not caused by primary nonfunction identified preoperative serum bilirubin and serum creatinine as significant predictors of outcome. Seven of 207 (3.4%) patients undergoing retransplantation died of recurrent HCV in their second allografts. Conclusion. The prevalence of HCV infection in patients undergoing retransplantation appears to have significantly increased since 1990. HCV infection is an independent risk factor for death after retransplantation, However, acceptable results are attainable in highly selected patients, i.e., those patients without severe hyperbilirubinemia and renal failure, and retransplantation remains the only viable option for patients whose allografts fail because of recurrent disease.