Published online Apr 7, 2015. doi: 10.3748/wjg.v21.i13.3912
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.