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Retransplantation for Recurrent Hepatitis C
Patricia A. Sheiner, Leona Kim Schluger, Sukru Emre, Swan N.
Thung, Johnson Y.N. Lau, Stephen R. Guy, Myron E. Schwartz, and
Charles M. Miller
Journal: Liv Trans & Surgery, Vol. 3, No. 2, 1997
Recurrence of hepatitis C virus (HCV) after orthotopic liver
transplant (OLT) may be mild or may lead to progressive liver
disease requiring retransplantation (re-OLT). Results of re-OLT for
hepatitis C are not well known. We analyzed outcomes in 14 patients
retransplanted for recurrent hepatitis C. All had evidence of
recurrent hepatitis on multiple biopsies. Polymerase chain reaction
(PCR) was performed in blood or tissue samples from 12 patients
when recurrence was suspected; all 12 were positive for HCV-RNA.
Explants showed chronic hepatitis with bridging necrosis in 3
patients, hepatitis with transition to cirrhosis in 2, hepatitis
and cirrhosis in 3, and cirrhosis alone in 2. In 2 patients, in
whom immunosuppression had been withheld for 4 to 6 weeks, there
was also evidence of chronic rejection. Four died of sepsis
perioperatively (median, 32.5 days; range, 9-59); pre-OLT, 3 of 4
had renal failure, and 1 had fever with no obvious source of
infection. Ten patients did well early after OLT and were
discharged. One patient was readmitted 6 weeks after discharge and
died of cytomegalovirus (CMV) infection 127 days after re-OLT. One
patient with concomitant vanishing bile duct syndrome, probably due
to chronic rejection, developed recurrent hepatitis and died of
progressive liver failure 161 days after re-OLT. Eight patients are
well at a median of 926 days (range, 315-1930) after re-OLT. Three
have evidence of mild recurrent hepatitis on liver biopsy, one is
overweight with severe steatosis on biopsy, and four have no
evidence of recurrent hepatitis. Retransplantation for hepatitis C
should be considered a viable option for patients who develop
end-stage hepatic dysfunction secondary to recurrent disease and
should be performed before development of infectious complications
and renal insufficiency.
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