Retrospective Cohort Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 14, 2016; 22(18): 4547-4558
Published online May 14, 2016. doi: 10.3748/wjg.v22.i18.4547
Predictive factors for survival and score application in liver retransplantation for hepatitis C recurrence
Alice Tung Wan Song, Rodolphe Sobesky, Carmen Vinaixa, Jérôme Dumortier, Sylvie Radenne, François Durand, Yvon Calmus, Géraldine Rousseau, Marianne Latournerie, Cyrille Feray, Valérie Delvart, Bruno Roche, Stéphanie Haim-Boukobza, Anne-Marie Roque-Afonso, Denis Castaing, Edson Abdala, Luiz Augusto Carneiro D’Albuquerque, Jean-Charles Duclos-Vallée, Marina Berenguer, Didier Samuel
Alice Tung Wan Song, Rodolphe Sobesky, Bruno Roche, Denis Castaing, Jean-Charles Duclos-Vallée, Didier Samuel, INSERM Unit 785, Villejuif 94800, France
Alice Tung Wan Song, Edson Abdala, Luiz Augusto Carneiro D’Albuquerque, Liver and Digestive Organ Transplantation Division, Gastroenterology Department, University of São Paulo Medical School, São Paulo 05403-900, Brazil
Alice Tung Wan Song, Rodolphe Sobesky, Bruno Roche, Denis Castaing, Jean-Charles Duclos-Vallée, Didier Samuel, Université Paris-Sud, Villejuif 94800, France
Alice Tung Wan Song, Luiz Augusto Carneiro D’Albuquerque, Liver Transplantation Laboratory LIM-37, São Paulo 01246-903, Brazil
Alice Tung Wan Song, Rodolphe Sobesky, Valérie Delvart, Bruno Roche, Stéphanie Haim-Boukobza, Anne-Marie Roque-Afonso, Denis Castaing, Jean-Charles Duclos-Vallée, Didier Samuel, AP-HP Hôpital Paul Brousse, Villejuif 94800, France
Carmen Vinaixa, Marina Berenguer, La Fe Hospital, University of Valencia and Ciberehd, Valencia 46026, Spain
Jérôme Dumortier, Hôpital Edouard Herriot, Lyon 69003, France
Sylvie Radenne, Hôpital Croix Rousse, Lyon 69004, France
François Durand, AP-HP Hôpital Beaujon, Clichy 92110, France
Yvon Calmus, AP-HP Hôpital St Antoine, Paris 75011, France
Géraldine Rousseau, AP-HP Hôpital Salpétrière, Paris 75013, France
Marianne Latournerie, CHU Pontchaillou, Rennes 35000, France
Cyrille Feray, AP-HP Hôpital Henri Mondor, Creteil 94010, France
Edson Abdala, Viral Hepatitis Laboratory LIM-47, São Paulo 01246-903, Brazil
Author contributions: Song ATW, Sobesky R, Castaing D, Abdala E, D’Albuquerque LAC, Duclos-Vallée JC, Berenguer M and Samuel D participated in research design; Song ATW, Sobesky R, Vinaixa C, Dumortier J, Radenne S, Durand F, Calmus Y, Rousseau G, Latournerie M, Feray C, Roche B, Haim-Boukobza S and Roque-Afonso AM participated in data collection; Song ATW and Delvart V participated in data analysis; Song ATW, Sobesky R, Vinaixa C, Abdala E, Berenguer M and Samuel D participated in writing the paper; all authors drafted the article and approved the final version of the submitted article.
Supported by A research grant from São Paulo Research Foundation (FAPESP grant number 2012/03895-6).
Institutional review board statement: The institutional review board of the Centre Hépato-Biliaire (Hôpital Paul Brousse) approved the study and written consent was obtained from all patients. Access to medical charts was in agreement with French ethical laws.
Informed consent statement: All study participants provided informed consent prior to study enrollment.
Conflict-of-interest statement: The authors did not receive any commercial financial support that could create conflicts of interest to this paper.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at alicetwsong@gmail.com. In all centers, participants gave informed consent for data sharing before transplantation.
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: Alice Tung Wan Song, MD, PhD, Liver and Digestive Organ Transplantation Division, Gastroenterology Department, University of São Paulo Medical School, São Paulo 05403-900, Brazil. alicetwsong@gmail.com
Telephone: +55-11-26613323 Fax: +55-11-26613323
Received: June 29, 2015
Peer-review started: July 3, 2015
First decision: September 29, 2015
Revised: November 26, 2015
Accepted: January 17, 2016
Article in press: January 18, 2016
Published online: May 14, 2016
Processing time: 310 Days and 6.6 Hours
Abstract

AIM: To identify risk factors associated with survival in patients retransplanted for hepatitis C virus (HCV) recurrence and to apply a survival score to this population.

METHODS: We retrospectively identified 108 patients retransplanted for HCV recurrence in eight European liver transplantation centers (seven in France, one in Spain). Data collection comprised clinical and laboratory variables, including virological and antiviral treatment data. We then analyzed the factors associated with survival in this population. A recently published score that predicts survival in retransplantation in patients with hepatitis C was applied. Because there are currently no uniform recommendations regarding selection of the best candidates for retransplantation in this setting, we also described the clinical characteristics of 164 patients not retransplanted, with F3, F4, or fibrosing cholestatic hepatitis (FCH) post-first graft presenting with hepatic decompensation.

RESULTS: Overall retransplantation patient survival rates were 55%, 47%, and 43% at 3, 5, and 10 years, respectively. Patients who were retransplanted for advanced cirrhosis had survival rates of 59%, 52%, and 49% at 3, 5, and 10 years, while those retransplanted for FCH had survival rates of 34%, 29%, and 11%, respectively. Under multivariate analysis, and adjusting for the center effect and the occurrence of FCH, factors associated with better survival after retransplantation were: negative HCV viremia before retransplantation, antiviral therapy after retransplantation, non-genotype 1, a Model for End-stage Liver Disease (MELD) score < 25 when replaced on the waiting list, and a retransplantation donor age < 60 years. Although the numbers were small, in the context of the new antivirals era, we showed that outcomes in patients who underwent retransplantation with undetectable HCV viremia did not depend on donor age and MELD score. The Andrés score was applied to 102 patients for whom all score variables were available, producing a mean score of 43.4 (SD = 6.6). Survival rates after the date of the first decompensation post-first liver transplantation (LT1) in the liver retransplantation (reLT) group (94 patients decompensated) at 3, 5, and 10 years were 62%, 59%, and 51%, respectively, among 78 retransplanted individuals with advanced cirrhosis, and 42%, 32%, and 16% among 16 retransplanted individuals with FCH. In the non-reLT group with hepatic decompensation, survival rates were 27%, 18%, and 9% at 3, 5, and 10 years, respectively (P < 0.0001). Compared with non-retransplanted patients, retransplanted patients were younger at LT1 (mean age 48 ± 8 years compared to 53 ± 9 years in the no reLT group, P < 0.0001), less likely to have human immunodeficiency virus (HIV) co-infection (4% vs 14% among no reLT patients, P = 0.005), more likely to have received corticosteroid bolus therapy after LT1 (25% in reLT vs 12% in the no reLT group, P = 0.01), and more likely to have presented with sustained virological response (SVR) after the first transplantation (20% in the reLT group vs 7% in the no reLT group, P = 0.028).

CONCLUSION: Antiviral therapy before and after retransplantation had a substantial impact on survival in the context of retransplantation for HCV recurrence, and with the new direct-acting antivirals now available, outcomes should be even better in the future.

Keywords: Antivirals; Hepatitis C; Mortality; Prognosis; Retransplantation; Risk factors

Core tip: Liver retransplantation for hepatitis C recurrence may be a subject of debate. This study was performed in order to assist patient selection for retransplantation in a context of donor scarcity. This retrospective multicenter study analyzed predictive factors for survival in a population of patients retransplanted for hepatitis C virus recurrence, including virological and antiviral treatment data. We also applied a previously published score to this population.