Please use this identifier to cite or link to this item: https://observatorio.fm.usp.br/handle/OPI/3201
Title: 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
Authors: SONG, A. T. W.SOBESKY, R.VINAIXA, C.DUMORTIER, J.RADENNE, S.ROUSSEAU, G.DELVART, V.HAIM-BOUKOBZA, S.ROQUE-AFONSO, A. -M.ROCHE, B.VIBERT, E.CASTAING, D.ABDALA, E.BERENGUER, M.DUCLOS-VALLEE, J. -C.SAMUEL, D.
Citation: JOURNAL OF HEPATOLOGY, v.58, suppl.1, p.S81-S81, 2013
Abstract: Background: Liver retransplantation (RT) is the only therapeutic option for irreversible failure of the liver graft. Indications and results of RT for HCV-related disease are debatable. Recently, a Swiss group proposed a retransplantation survival score specifically designed for HCV-positive patients in order to aid in candidate selection. Aim: To identify risk factors associated with survival in patients retransplanted for HCV-related disease, and to evaluate the Andres survival score in this population. Methods: We have conducted a retrospective and multicentric study (4 centers) to determine prognostic factors of 3, 5 and 10-year patient survival. Results: Sixty-seven patients were retransplanted for HCV recurrence, from January 1984 until September 2012. Baseline characteristics were: 76.1% males, mean age 53 ± 9 years, genotype 1 in 44 (75.9%), 19 (29.7%) received corticosteroid boluses after RT, 38 (56.7%) received HCV therapy before RT, and of these, 7 (10.4%) presented SVR. Mean MELD score at RT was 24 ± 8. Overall, 3, 5 and 10-year survival rates were 65%, 57%, and 53% respectively. Among 37 patients in whom data for Andres score application was available, 26 (70.3%) had a score above 40. For patients with an Andres score below 40 and above 40, 5-year survival was 81% and 47%, respectively. In univariate analysis, factors potentially associated with better survival were: female gender (p=0.04), deceased donor versus living or domino (p=0.02), undetectable HCV viremia before RT (p=0.059), tacrolimus-based immunosupression after RT (p=0.047), antiviral treatment after RT (p=0.01), lower BMI (p=0.01), younger age at first transplantation (p=0.027), longer interval between first transplantation and RT (p=0.037) and Andres score below 40 (p=0.098). In multivariate analysis, factors associated with survival were: undetectable HCV- RNA before RT (p=0.044, RR=8.42), lower BMI at RT (p=0.009, RR=1.13), and antiviral treatment after RT (p=0.015, RR=0.33). Conclusions: Overall 3, 5 and 10-year survival rates were 65%, 57%, and 53% respectively. Anti-HCV therapy before and after RT represents a major prognostic factor, and patients that received therapy before RT or are potentially able to receive it after RT, may have good prognosis. In our cohort, Andres score underestimated survival rates.
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Comunicações em Eventos - HC/ICESP
Instituto do Câncer do Estado de São Paulo - HC/ICESP

Comunicações em Eventos - LIM/37
LIM/37 - Laboratório de Transplante e Cirurgia de Fígado


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