Brief Article
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World J Gastroenterol. Oct 28, 2010; 16(40): 5070-5076
Published online Oct 28, 2010. doi: 10.3748/wjg.v16.i40.5070
Retransplantation for graft failure in chronic hepatitis C infection: A good use of a scarce resource?
Ian A Rowe, Kerri M Barber, Rhiannon Birch, Elinor Curnow, James M Neuberger
Ian A Rowe, James M Neuberger, Liver and Hepatobiliary Unit, University Hospital Birmingham NHS Trust, Queen Elizabeth Hospital, Birmingham, B15 2TH, United Kingdom
Kerri M Barber, Rhiannon Birch, Elinor Curnow, James M Neuberger, NHS Blood and Transplant, Fox Den Road, Stoke Gifford, Bristol, BS34 8RR, United Kingdom
Author contributions: Rowe IA and Neuberger JM designed the study, analyzed the data and wrote the paper; Barber K designed the study and analyzed the data; Birch R and Curnow E analyzed the data.
Correspondence to: Dr. Ian A Rowe, Liver and Hepatobiliary Unit, University Hospital Birmingham NHS Trust, Queen Elizabeth Hospital, Birmingham, B15 2TH, United Kingdom. i.a.c.rowe@bham.ac.uk
Telephone: +44-121-4146846 Fax: +44-121-4158701
Received: April 24, 2010
Revised: June 16, 2010
Accepted: June 23, 2010
Published online: October 28, 2010
Abstract

AIM: To investigate the outcome of patients with hepatitis C virus (HCV) infection undergoing liver retransplantation.

METHODS: Using the UK National Registry, patients undergoing liver transplantation for HCV-related liver disease were identified. Data on patient and graft characteristics, as well as transplant and graft survival were collected to determine the outcome of HCV patients undergoing retransplantation and in order to identify factors associated with transplant survival.

RESULTS: Between March 1994 and December 2007, 944 adult patients were transplanted for HCV-related liver disease. At the end of follow-up, 617 of these patients were alive. In total, 194 (21%) patients had first graft failure and of these, 80 underwent liver retransplantation, including 34 patients where the first graft failed due to recurrent disease. For those transplanted for HCV-related disease, the 5-year graft survival in those retransplanted for recurrent HCV was 45% [95% confidence interval (CI): 24%-64%] compared with 80% (95% CI: 62%-90%) for those retransplanted for other indications (P = 0.01, log-rank test); the 5-year transplant survival after retransplantation was 43% (95% CI: 23%-62%) and 46% (95% CI: 31%-60%), respectively (P = 0.8, log-rank test). In univariate analysis of all patients retransplanted, no factor analyzed was significantly associated with transplant survival.

CONCLUSION: Outcomes for retransplantation in patients with HCV infection approach agreed criteria for minimum transplant benefit. These data support selective liver retransplantation in patients with HCV infection.

Keywords: Hepatitis C; Liver; Recurrence; Retransplantation; Outcome