Liver Transplant in Young Adults with Chronic Hepatitis C Virus: An Argument for Hepatitis C Treatment in Childhood

被引:1
|
作者
Mohamad, Bashar [1 ,2 ]
Hanouneh, Ibrahim A. [1 ,2 ]
Zein, Nizar N. [1 ,2 ]
Lopez, Rocio [3 ]
Matloob, Ammar [1 ,2 ]
Alkhouri, Naim [1 ,2 ]
机构
[1] Cleveland Clin, Dept Gastroenterol & Hepatol, Cleveland, OH 44106 USA
[2] Cleveland Clin, Inst Digest Dis, Cleveland, OH 44106 USA
[3] Cleveland Clin, Dept Quantitat Hlth Sci, Cleveland, OH 44106 USA
关键词
End-stage liver disease; Viral hepatitis; Pediatric patients; Graft; Outcomes; UNITED-STATES; INFECTION; CHILDREN; PROGRESSION; GUIDELINES; MANAGEMENT; RECIPIENTS;
D O I
10.6002/ect.2015.0092
中图分类号
R3 [基础医学]; R4 [临床医学];
学科分类号
1001 ; 1002 ; 100602 ;
摘要
Objectives: We sought to assess the characteristics of hepatitis C virus-positive young adults who received a liver transplant and to evaluate posttransplant outcomes. Materials and Methods: United Network for Organ Sharing database was conducted from 1989 to 2012, and retrospective analysis was performed on all hepatitis C virus-positive young adult patients (aged, 8-35 y) who underwent a liver transplant in the United States. Results: A total of 506 hepatitis C virus subjects were included. Average age at time of transplant was 30.1 +/- 4.8 years. Median follow-up after first liver transplant was 46.1 months (13, 89.3 mo). During this time, 217 patients (42.8%) died at a mean age at the time of death of 34 +/- 6.7 years including 176/506 (34.8%) after the first liver transplant, 34/71 (48.6%) after the second liver transplant, and 7/8 (87.5%) after the third liver transplant. The majority (65.7%) of retransplants were performed for hepatitis C virus recurrence. A mean of 1.15 liver transplants were performed per patient. Overall, 262 subjects were transplanted in the pre-Model for End-stage Liver Disease era, and 244 were transplanted post-MELD. Younger age, higher bilirubin, higher creatinine, hepatitis C carcinoma, shorter wait time, shorter cold ischemia time, nonwhite donor race, and the use of mycophenolate mofetil were significantly more common in the post-Model for End-stage Liver Disease era (all with P<.05). Importantly, 5-year patient and graft survival were not different between the pre- and post-Model for End-stage Liver Disease era. Conclusions: Liver transplant in young adults for hepatitis C virus acquired during childhood has poor outcomes that did not improve in the post-Model for End-stage Liver Disease era. These findings should prompt more aggressive evaluation and treatment for hepatitis C virus in children.
引用
收藏
页码:201 / 206
页数:6
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