Liver transplantation in hepatitis C. A Spanish multi-centre experience

Objective The purpose of this retrospective survey was to determine the prevalence and outcome of hepatitis C virus (HCV) infection in cirrhotic patients undergoing liver transplantation (OLT) in Spain in 1992. Methods Post-OLT HCV infection was defined by anti-HCV (second-generation ELISA) and/or PCR. Patients were divided into groups A (HCV-positive pre-OLT: n=124, 46%) and B (HCV-negative pre-OLT: n=145, 54%). Results HCV infection was more prevalent in patients originally diagnosed as having non-A non-B cirrhosis (97%) and cryptogenic cirrhosis (79%) than in patients with cholestatic or metabolic diseases. Group A patients were older (53.3 +/- 7.9 versus 47.6 +/- 9.7; P < 0.05) and had a higher prevalence of hepatocellular carcinoma (22% versus 4%, P < 0.05). Post-OLT HCV infection was 99% in group A versus 4% in group B (P < 0.05). Histological hepatitis developed in 39% (66% in group A versus 14% in group B, P < 0.05) with similar follow-up. Chronic rejection occurred in 6% (3% in group A versus 8.5% in group B, P = 0.07). Retransplantation rate (overall 8%) and two-year patient survival did not differ between groups (79% versus 72%). Graft survival was higher in group A (74% versus 65% at 2 years, P = 0.04). Conclusions HCV-cirrhosis represented the most frequent indication for OLT in Spain in 1992. While HCV recurrence was universal, de novo acquisition was rare. HCV accounted for most post-OLT hepatitis (87%), but was not associated with chronic rejection, nor with a higher retransplantation rate. Patient survival was not different in HCV patients compared to a control group after a follow-up of 2-3 years. Therefore, at present, HCV-cirrhosis is an acceptable indication for OLT. Eur J Gastroenterol Hepatol 10:771-776 (C) 1998 Lippincott Williams & Wilkins.