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©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
Hepatitis C virus recurrence after liver transplantation: A 10-year evaluation
Stefano Gitto, Luca Saverio Belli, Ranka Vukotic, Stefania Lorenzini, Aldo Airoldi, Arrigo Francesco Giuseppe Cicero, Marcello Vangeli, Lucia Brodosi, Arianna Martello Panno, Roberto Di Donato, Matteo Cescon, Gian Luca Grazi, Luciano De Carlis, Antonio Daniele Pinna, Mauro Bernardi, Pietro Andreone
Stefano Gitto, Ranka Vukotic, Stefania Lorenzini, Arrigo Francesco Giuseppe Cicero, Lucia Brodosi, Arianna Martello Panno, Roberto Di Donato, Matteo Cescon, Gian Luca Grazi, Antonio Daniele Pinna, Mauro Bernardi, Pietro Andreone, Department of Medical and Surgical Sciences, University of Bologna and Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant’Orsola Malpighi, 40138 Bologna, Italy
Stefano Gitto, Department of Gastroenterology, Azienda Ospedaliero-Universitaria and University of Modena and Reggio Emilia, 41124 Modena, Italy
Luca Saverio Belli, Aldo Airoldi, Marcello Vangeli, Department of Hepatology and Gastroenterology, Niguarda Hospital, 20162 Milan, Italy
Gian Luca Grazi, Hepatobiliopancreatic and General Surgery Unit, Regina Elena Institute, 00186 Rome, Italy
Luciano De Carlis, Department of General Surgery and Transplantation, Niguarda Hospital, 20162 Milan, Italy
Author contributions: Gitto S conceived of and designed the study, performed the database creation, data collection and critical analyses, drafted the manuscript and revised it for scientific content; Belli LS contributed to the study design, data collection and interpretation and to the critical revision of the manuscript; Vukotic R contributed to the interpretation of the data, to manuscript drafting and critical revision for scientific content; Lorenzini S contributed to the study design and data collection; Airoldi A contributed to data collection; Cicero AFG performed the statistical analyses; Vangeli M contributed to data collection; Brodosi L contributed to the data collection; Panno AM contributed to data collection; Di Donato R contributed to data collection; Cescon M, Grazi GL, De Carlis L and Pinna AD contributed to the study design and to data collection; Bernardi M revised the draft for scientific content; and Andreone P conceived of and designed the study, contributed to the interpretation of the data and to the revision of the draft for scientific content, and is the guarantor of this review article; all authors approved the final version of the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Pietro Andreone, MD, Professor, Department of Medical and Surgical Sciences, University of Bologna and Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant’Orsola Malpighi, Via Massarenti 9, 40138 Bologna, Italy.
pietro.andreone@unibo.it
Telephone: +39-51-2143618 Fax: +39-51-345806
Received: August 7, 2014
Peer-review started: August 8, 2014
First decision: August 27, 2014
Revised: October 10, 2014
Accepted: November 18, 2014
Article in press: November 19, 2014
Published online: April 7, 2015
Processing time: 242 Days and 17.5 Hours
AIM: To evaluate the predictors of 10-year survival of patients with hepatitis C recurrence.
METHODS: Data from 358 patients transplanted between 1989 and 2010 in two Italian transplant centers and with evidence of hepatitis C recurrence were analyzed. A χ2, Fisher’s exact test and Kruskal Wallis’ test were used for categorical and continuous variables, respectively. Survival analysis was performed at 10 years after transplant using the Kaplan-Meier method, and a log-rank test was used to compare groups. A P level less than 0.05 was considered significant for all tests. Multivariate analysis of the predictive role of different variables on 10-year survival was performed by a stepwise Cox logistic regression.
RESULTS: The ten-year survival of the entire population was 61.2%. Five groups of patients were identified according to the virological response or lack of a response to antiviral treatment and, among those who were not treated, according to the clinical status (mild hepatitis C recurrence, “too sick to be treated” and patients with comorbidities contraindicating the treatment). While the 10-year survival of treated and untreated patients was not different (59.1% vs 64.7%, P = 0.192), patients with a sustained virological response had a higher 10-year survival rate than both the “non-responders” (84.7% vs 39.8%, P < 0.0001) and too sick to be treated (84.7% vs 0%, P < 0.0001). Sustained virological responders had a survival rate comparable to patients untreated with mild recurrence (84.7% vs 89.3%). A sustained virological response and young donor age were independent predictors of 10-year survival.
CONCLUSION: Sustained virological response significantly increased long-term survival. Awaiting the interferon-free regimen global availability, antiviral treatment might be questionable in selected subjects with mild hepatitis C recurrence.
Core tip: The recurrence of hepatitis C virus (HCV) infection after liver transplantation is still a great clinical challenge. Currently, the treatment opportunities are growing with the development of new antivirals; however, in several countries, their availability will not be immediate. The decision to start treatment for HCV recurrence might be difficult in some cases, and the data on the long-term impact are extremely useful in this setting. This study reports the results of 10-year survival analysis on an Italian cohort of liver transplant cases focusing on the differences in outcomes, not only between the treated and not-treated subjects but also in specific subgroups of patients with mild recurrence and those considered too sick to be treated.
