Severe recurrent hepatitis C after liver retransplantation for hepatitis C virus-related graft cirrhosis

被引:80
作者
Berenguer, M
Prieto, M
Palau, A
Rayón, J
Carrasco, D
San Juan, F
López-Labrador, FX
Moreno, R
Mir, J
Berenguer, J
机构
[1] Hosp Univ La Fe, Serv Hepatogastroenterol, Valencia, Spain
[2] Hosp Univ La Fe, Pathol Serv, Valencia, Spain
[3] Hosp Univ La Fe, Liver Transplantat & Surg Unit, Valencia, Spain
[4] Hosp Univ La Fe, Microbiol Serv, Valencia, Spain
关键词
LONG-TERM; TRANSPLANTATION; INFECTION; SURVIVAL; PROGRESSION; FAILURE;
D O I
10.1053/jlts.2003.50029
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
An increase in the number of hepatitis C virus (HCV)-infected transplant recipients at need for repeated liver transplantation is anticipated. To date, there is a certain reluctance to accept these patients because of an increased organ shortage, early reports suggesting a poor outcome, and uncertainty regarding the natural history of recurrent hepatitis C in the second graft. The aim of this study is to determine the outcome of patients undergoing retransplantation for HCV-related graft cirrhosis. Of 49 transplant recipients with HCV-related allograft cirrhosis, 31 patients developed decompensation with criteria for retransplantation. Thirteen patients were denied this option. Of the 18 patients accepted, 6 patients died while on the waiting list (5 patients died of graft cirrhosis at a median of 3.2 months of listing), and 12 patients have undergone retransplantation (median, 10 months since HCV cirrhosis). After retransplantation, 8 patients (67%) died at a median of 8 months, and 4 patients (33%) remain alive after 1.9 years of follow-up. Causes and times of death from retransplantation were: surgical complications, n=3 (perioperative period); HCV cirrhosis of the second graft, n=2 (at 9 and 54 months); fibrosing cholestatic hepatitis, n=1 (at 2 years); lymphoproliferative disorder, n=1 (at 7 months); and endocarditis, n=1 (at 3.5 years, with underlying cirrhosis). Of the 4 patients alive, fibrosis stages in the last biopsy specimens are stage 1 (n=1), stage 3 (n=1), and stage 4 or cirrhosis (n=1; one patient has not undergone biopsy), despite antiviral therapy. The outcome of retransplantation for HCV cirrhosis of the first graft is very poor because of multiple complications. The severity of recurrent HCV disease in the second graft seems to be related to that observed in the first graft.
引用
收藏
页码:228 / 235
页数:8
相关论文
共 19 条
[1]   Natural history of clinically compensated hepatitis C virus-related graft cirrhosis after liver transplantation [J].
Berenguer, M ;
Prieto, M ;
Rayón, JM ;
Mora, J ;
Pastor, M ;
Ortiz, V ;
Carrasco, D ;
San Juan, F ;
Burgueño, MDJ ;
Mir, J ;
Berenguer, J .
HEPATOLOGY, 2000, 32 (04) :852-858
[2]  
Berenguer M, 2001, J HEPATOL, V35, P666, DOI 10.1016/S0168-8278(01)00179-9
[3]   Contribution of donor age to the recent decrease in patient survival among HCV-infected liver transplant recipients [J].
Berenguer, M ;
Prieto, M ;
San Juan, F ;
Rayón, JM ;
Martinez, F ;
Carrasco, D ;
Moya, A ;
Orbis, F ;
Mir, J ;
Berenguer, J .
HEPATOLOGY, 2002, 36 (01) :202-210
[4]   HCV-related fibrosis progression following liver transplantation:: increase in recent years [J].
Berenguer, M ;
Ferrell, L ;
Watson, J ;
Prieto, M ;
Kim, M ;
Rayón, M ;
Córdoba, J ;
Herola, A ;
Ascher, N ;
Mir, J ;
Berenguer, J ;
Wright, TL .
JOURNAL OF HEPATOLOGY, 2000, 32 (04) :673-684
[5]   Are posttransplantation protocol liver biopsies useful in the long term? [J].
Berenguer, M ;
Rayón, JM ;
Prieto, M ;
Aguilera, V ;
Nicolás, D ;
Ortiz, V ;
Carrasco, D ;
López-Andujar, R ;
Mir, J ;
Berenguer, J .
LIVER TRANSPLANTATION, 2001, 7 (09) :790-796
[6]   Retransplantation for hepatic allograft failure: Prognostic modeling and ethical considerations [J].
Biggins, SW ;
Beldecos, A ;
Rabkin, JM ;
Rosen, HR .
LIVER TRANSPLANTATION, 2002, 8 (04) :313-322
[7]   Long-term outcome of hepatitis C infection after liver transplantation [J].
Cane, EJ ;
Portmann, BC ;
Naoumov, NV ;
Smith, HM ;
Underhill, JA ;
Donaldson, PT ;
Maertens, G ;
Williams, R .
NEW ENGLAND JOURNAL OF MEDICINE, 1996, 334 (13) :815-820
[8]   Retransplantation for late liver graft failure: Predictors of mortality [J].
Facciuto, M ;
Heidt, D ;
Guarrera, J ;
Bodian, CA ;
Miller, CM ;
Emre, S ;
Guy, SR ;
Fishbein, TM ;
Schwartz, ME ;
Sheiner, PA .
LIVER TRANSPLANTATION, 2000, 6 (02) :174-179
[9]   European collaborative study on factors influencing outcome after liver transplantation for hepatitis C [J].
Féray, C ;
Caccamo, L ;
Alexander, GJM ;
Ducot, B ;
Gugenheim, J ;
Casanovas, T ;
Loinaz, C ;
Gigou, M ;
Burra, P ;
Barkholt, L ;
Esteban, R ;
Bizollon, T ;
Lerut, J ;
Minello-Franza, A ;
Bernard, PH ;
Nachbaur, G ;
Botta-Fridlund, D ;
Bismuth, H ;
Schalm, SW ;
Samuel, D .
GASTROENTEROLOGY, 1999, 117 (03) :619-625
[10]   The association between hepatitis C infection and survival after orthotopic liver transplantation [J].
Forman, LM ;
Lewis, JD ;
Berlin, JA ;
Feldman, HI ;
Lucey, MR .
GASTROENTEROLOGY, 2002, 122 (04) :889-896