Risk stratification of allograft failure secondary to hepatitis C recurrence after liver transplantation.

AimHepatitis C virus (HCV) recurrence after liver transplantation decreases survival rates. Improved understanding of the multiple factors influencing HCV recurrence could aid decision-making for donor-recipient pairing and maximize transplant outcomes. The aim of this study was to create a model based on pretransplant variables to stratify patients at risk of HCV-related allograft failure. MethodsThis retrospective study enrolled 154 liver transplant recipients with HCV at Cleveland Clinic. ResultsAmong the study population, 54 recipients (35.1%) experienced HCV recurrence, histologically defined as moderate to severe hepatitis and/or bridging fibrosis to cirrhosis. The multivariate analysis found donor age (60years, P<0.002), donor body mass index (30kg/m(2), P<0.05), African American recipient (P<0.01) and genotype 1 (P<0.02) as risk factors for HCV-related allograft failure. When these four factors were scored as a combined index (no factor [n=15], one factor [n=76], two factors [n=43] and three or more factors [n=20]), the HCV recurrence-free survival showed good stratification according to the scores: 93.3% with no factor, 79.3% with one factor, 52.0% with two factors and 24.4% with three or more factors at 3years after transplant (P<0.0001). Moreover, this risk index also identified the patient group at high risk of HCV recurrence after acute rejection. ConclusionWhile the introduction of direct-acting antiviral agents has been changing the paradigm of HCV treatment, the natural history of recipients with HCV as shown in this study would help estimate the risk of HCV-related allograft failure in those who do not tolerate such new treatment.