Predictive factors for survival and score application in liver retransplantation for hepatitis C recurrence

Table 1 Distribution of hepatitis C virus-related cases of advanced fibrosis/fibrosing cholestatic hepatitis cases after liver transplantation with and without liver retransplantation according to center n (%)

Center	n (LT)	LT related to HCV (percent of total LT)	F3/F4/FCH after LT (percent of LT for HCV)	F3/F4/FCH reLT (percent of LT for HCV)	F3/F4/FCH without ReLT (percent of LT for HCV)
1	1933	770 (40)	174 (23)	31 (4)	143 (19)
2	2001	420 (21)	108 (26)	26 (6)	82 (20)
3	2124	412 (19)	20 (5)	12 (3)	8 (2)
4	1477	321 (22)	40 (12)	11 (3)	29 (9)
5	920	247 (27)	33 (13)	10 (4)	23 (9)
6	1576	141 (9)	16 (11)	8 (6)	8 (6)
7	450	143 (32)	16 (11)	8 (6)	8 (6)
8	860	132 (15)	8 (6)	2 (2)	6 (5)
Total	11341	2586 (23)	415 (16)	108 (4)	307 (12)

LT: Liver transplantation; reLT: Liver retransplantation; HCV: Hepatitis C virus; F3: Metavir score F3; F4: Metavir score F4; FCH: Fibrosing cholestatic hepatitis.

Table 2 Donor age, MELD score, and outcomes in patients undergoing liver retransplantation for hepatitis C virus recurrence with undetectable hepatitis C virus viremia before liver retransplantation

reLT donor age (yr)	reLT MELD score	Outcome
14	35	Alive
19	22	Deceased
20	24	Alive
23	16	Alive
24	25	Alive
31	17	Alive
35	23	Alive
46	33	Deceased
47	38	Alive
52	26	Alive
58	21	Alive
60	28	Alive
62	14	Alive

reLT: Liver retransplantation; MELD: Model for End-stage Liver Disease.

Table 3 Univariate analysis of qualitative variables associated with survival in retransplanted patients for hepatitis C virus recurrence

Risk factor	n	Survival estimation			Log-rank P value
		3 yr	5 yr	10 yr
HIV serology
Negative	104	57%	49%	45%	0.006
Positive	4	0%
IS after LT1
Without MMF	82	58%	51%	47%	0.060
With MMF	26	45%	33%	0%
Genotype 1
No	23	69%	69%	69%	0.110
Yes	69	55%	45%	41%
HCV viremia pre-reLT
Negative	14	86%	86%	86%	0.005
Positive	94	50%	41%	36%
Dialysis pre-reLT
Yes	19	74%	67%	67%	0.060
No	89	51%	43%	37%
Split graft at reLT
No	101	57%	48%	44%	0.060
Yes	7	29%	29%	0%
IS after reLT
With tacrolimus	62	67%	57%	53%	0.038
Without tacrolimus	41	43%	37%	30%
Antiviral therapy post-reLT
Yes	35	85%	75%	64%	0.0003
No	63	44%	36%	36%
Antiviral response post-reLT
SVR	14	93%	93%	93%	0.039
Partial or NR	18	77%	59%	43%
FCH post-LT1
No	90	59%	52%	49%	0.018
Yes	18	34%	23%	0%
Arterial complications post-reLT					0.030
No	90	62%	53%	48%
Yes	11	27%	27%	27%
Andres score > 40
No	35	71%	64%	64%	0.019
Yes	67	49%	40%	37%
Reinscription MELD < 25					0.026
No	30	39%	34%	34%
Yes	72	66%	58%	51%

HIV: Human immunodeficiency virus; IS: Immunosuppression; LT1: First liver transplantation; MMF: Mycophenolate mophetil; HCV: Hepatitis C virus; reLT: Liver retransplantation; SVR: Sustained virological response; NR: Non-responder; FCH: Fibrosing cholestatic hepatitis; MELD: Model for End-stage Liver Disease.

Table 4 Univariate analysis of quantitative variables associated with survival in retransplanted patients for hepatitis C virus recurrence

Risk factor	Hazard ratio	95%CI	P value
Less days under MV pre-reLT	1.25	1.02-1.52	0.031
Lower reLT donor age	1.02	1.00-1.04	0.017
Lower recipient age at LT1	1.04	1.00-1.08	0.027
Greater interval between LT1 and reLT	0.88	0.82-0.96	0.002

MV: Mechanical ventilation; reLT: Liver retransplantation; LT1: First liver transplantation.

Table 5 Factors associated with survival according to multivariate analysis in patients undergoing liver retransplantation for hepatitis C virus recurrence, adjusted for center effect and fibrosing cholestatic hepatitis occurrence

Risk factor	Hazard ratio	95%CI	P value
Undetectable HCV viremia pre-reLT	8.80	1.96-39.39	0.004
Receipt of antiviral treatment after reLT	4.98	2.23-11.15	< 0.0001
ReLT donor age < 60 yr	3.54	1.42-8.82	0.007
Non-genotype 1	3.94	1.35-11.57	0.010
Reinscription MELD ≤ 25	2.45	1.23-4.88	0.010

HCV: Hepatitis C virus; reLT: Liver retransplantation; MELD: Model for End-stage Liver Disease.

Table 6 Survival estimation according to the presence of each of the independent mortality risk factors

RT inscription MELD > 25	Genotype 1	RT donor age > 60 yr	No antiviral treatment post-RT	HCV viremia pre-RT	Number of factors	Survival
						1 yr	3 yr	5 yr
-	-	-	-	-	0	99.7%	99.5%	99.3%
+	-	-	-	-	1	99.1%	98.7%	98.3%
-	+	-	-	-		98.8%	98.1%	97.2%
-	-	+	-	-		99.0%	97.9%	97.0%
-	-	-	+	-		98.6%	97.7%	96.8%
-	-	-	-	+		98.0%	96.2%	94.8%
+	+	-	-	-	2	97.4%	95.3%	94.6%
+	-	+	-	-		97.7%	95.9%	94.3%
+	-	-	+	-		96.9%	95.1%	93.2%
-	+	+	-	-		96.0%	93.4%	90.8%
+	-	-	-	+		95.3%	91.7%	88.3%
-	+	-	+	-		94.8%	91.3%	87.9%
-	-	+	+	-		94.8%	90.7%	87.3%
-	+	-	-	+		91.3%	85.9%	81.0%
-	-	+	-	+		91.3%	85.7%	79.6%
-	-	-	+	+		87.0%	79.4%	71.2%
+	+	+	-	-	3	92.3%	87.8%	83.2%
+	+	-	+	-		89.4%	82.5%	76.4%
+	+	-	-	+		83.2%	73.1%1	63.9%
+	-	+	-	+		82.5%	72.1%	63.1%
-	+	+	+	-		82.0%	71.2%	61.9%
+	-	-	+	+		75.2%	61.4%	50.3%
+	-	+	+	-		72.5%	58.1%	47.0%
-	+	+	-	+		71.1%	56.3%	44.5%
-	+	-	+	+		61.2%	42.7%	30.2%
-	-	+	+	+		59.9%	41.6%	28.5%
+	+	+	+	-	4	67.2%	50.5%	37.9%
+	+	+	-	+		52.0%	32.4%	20.1%
+	+	-	+	+		36.9%	18.1%1	8.9%
+	-	+	+	+		35.7%	17.1%	8.3%
-	+	+	+	+		17.0%	4.5%	1.5%
+	+	+	+	+	5	2.8%	0.3%	0.0%

¹Two situations that underline the importance of HCV therapy after reLT. HCV: Hepatitis C virus; MELD: Model for End-stage Liver Disease.