Histological recurrent hepatitis C after liver transplantation: Outcome and role of retransplantation

Impact of hepatitis C virus (HCV) recurrence on long-term outcome after orthotopic liver transplantation (OLT) is highly variable, and the role of retransplantation is still debated. From 1996 to 2003, 131 OLT with histologically proven HCV recurrence and 6 months of follow-up were retrospectively reviewed. One and 5-yr overall survivals were 90.7 and 81.3%, respectively. The mean time of HCV recurrence was 10.1 ± 6.2 months in patients whose donor's age was less than 70 yr old, and 6.6 ± 4.7 in patients whose donor's age was more than 70 (P <0.01). The mean time between OLT and HCV recurrence was 10.7 ± 8.2 months among patients still alive, and 5 ± 4.2 among the 20 who died (P = 0.02). In 16 (12.2%) patients, retransplantation was required for severe HCV recurrence; 5 are still alive and 11 (68.7%) died. The mean survival time was 16.2 ± 6 months if re-OLT was performed within 12 months from first OLT, and it was 45.9 ± 10 months if re-OLT was performed later (P <0.01). In conclusion, donors older than 70 yr are at high risk of early HCV recurrence; expectancy of life is significantly reduced in case of histologically proven recurrence within 6 months. Outcome is quite dismal in patients with early HCV recurrence requiring retransplantation within 1 yr of first OLT.