Clinical outcome of patients infected with hepatitis c virus infection on survival after primary liver transplantation under tacrolimus

The outcome of hepatitis C virus (HCV) infection on patient and graft survival after orthotopic liver transplantation (OLT) has been controversial. An earlier experience with a higher dose of tacrolimus (greater than or equal to 0.1 mg/kg/d intravenously and greater than or equal to 0.2 mg/kg/d orally) was associated with a worse clinical outcome in patients infected with HCV. The clinical outcome of 183 liver transplant recipients with end-stage river disease (ESLD) secondary to HCV infection (HCV group) was compared with a contemporary cohort of 556 patients with HCV infection who underwent transplantation for nonviral, nonmalignant ESLD (control group). Art patients were prospectively screened for anti-HCV antibodies and HCV RNA by reverse-transcriptase polymerase chain reaction. All OLT patients were receiving low-dose tacrolimus immunosuppression. Cumulative patient survival rates for the HCV group were 80% after 1 year and 75% after 3 years compared with rates of 84% and 78%, respectively, in the control group (P = .452), Primary graft survival rates at the same time intervals for the HCV group and the control group were 72% and 77.5% at 1 year and 67% and 72% at 3 years, respectively (P = .144), The incidence of re-transplantation (re-OLT) in the HCV group and the control group was 12.6% and 10.4%, respectively (P = .42), Chronic HCV infection as an indication for OLT with a lower dose of tacrolimus immunosuppression (less than or equal to 0.05 mg/kg/d intravenously and less than or equal to 0.1 mg/kg/d orally) is associated with a similar patient and graft survival as those without HCV infection. (C) 1998 by the American Association for the Study of Liver Diseases.