Predictive Factors of Survival and Prognostic Score Validation in Liver Retransplantation for Severe Hepatitis C Recurrence: The Importance of HCV Therapy before and after Retransplantation

Abstract

Indications and results of retransplantation (RT) for HCV recurrence are debatable. Recently, a Swiss group proposed the Andres RT survival score specifically designed for HCV-positive patients. Aim: To identify risk factors associated with survival in RT patients for HCV recurrence and to evaluate the Andres score. Methods: Retrospective and multicentric study to determine prognostic factors of survival. A cohort of patients presenting F4 or FCH without RT was also analysed. Results: From 1984 to 2012, 77 patients were retransplanted for HCV recurrence. 79% were males, mean age 53±9 years, genotype 1 in 74%, 58.4% received HCV therapy preRT. MELD at RT was 24±8 and 25.7% received steroid boluses post-RT. Overall, 3, 5 and 10-year survival rates were 63%, 55%, and 52% respectively. 79% had an Andres score >40 (n=48). Andres score underestimated survival, as in their cohort, those with a score >40 presented a 5y survival of 27%. 42 patients with F4 or FCH post-transplant presenting decompensation presented survival rates of 15%, 7% and 0% at 3, 5 and 10 ys (p<0.0001). In univariate analysis, factors associated with better survival post-RT were: male gender (p=0.08), non-genotype 1 (p=0.06), interval between 1st transplant and acute hepatitis (p=0.006), undetectable viremia preRT (p=0.04), tacrolimus post-RT (p=0.08), HCV therapy post-RT (p=0.002), preRT bilirubin (p=0.04), RT donor age (p=0.06), recipient age at 1st transplant (p=0.06), interval between 1st transplant and RT (p=0.05), lower Andres score (p=0.006). In multivariate analysis, factors associated with survival were: HCV therapy post-RT (p=0.01), recipient age at 1st transplant (p=0.03), RT donor age (p=0.03), pre-RT bilirubin (p=0.01), non-genotype 1 (p=0.02). Conclusions: HCV therapy post-RT, non-genotype 1, recipient and RT donor age represent major prognostic factors for RT.