Predictive factors for survival and score application in liver retransplantation for hepatitis C recurrence

Autor(es):Mostrar menos -

Wan Song, Alice Tung ^{[1, 2, 3, 4, 5]} ; Sobesky, Rodolphe ^{[1, 3, 5]} ; Vinaixa, Carmen ^{[6, 7]} ; Dumortier, Jerome ^[8] ; Radenne, Sylvie ^[9] ; Durand, Franois ^[10] ; Calmus, Yvon ^[11] ; Rousseau, Geraldine ^[12] ; Latournerie, Marianne ^[13] ; Feray, Cyrille ^[14] ; Delvart, Valerie ^[5] ; Roche, Bruno ^{[1, 3, 5]} ; Haim-Boukobza, Stephanie ^[5] ; Roque-Afonso, Anne-Marie ^[5] ; Castaing, Denis ^{[1, 3]} ; Abdala, Edson ^{[2, 15]} ; Carneiro D'Albuquerque, Luiz Augusto ^{[2, 4]} ; Duclos-Vallee, Jean-Charles ^{[1, 3, 5]} ; Berenguer, Marina ^{[6, 7]} ; Samuel, Didier ^{[1, 3, 5]}

Afiliação do(s) autor(es):Mostrar menos -

^[1] INSERM, U785, F-94800 Villejuif - France

^[2] Univ Sao Paulo, Sch Med, Dept Gastroenterol, Liver & Digest Organ Transplantat Div, BR-05403900 Sao Paulo - Brazil

^[3] Univ Paris 11, F-94800 Villejuif - France

^[4] Liver Transplantat Lab LIM 37, BR-01246903 Sao Paulo - Brazil

^[5] Hop Paul Brousse, AP HP, F-94800 Villejuif - France

^[6] Univ Valencia, La Fe Hosp, Valencia 46026 - Spain

^[7] Ciberehd, Valencia 46026 - Spain

^[8] Hop Edouard Herriot, F-69003 Lyon - France

^[9] Hop Croix Rousse, F-69004 Lyon - France

^[10] Hop Beaujon, AP HP, F-92110 Clichy - France

^[11] Hop St Antoine, AP HP, F-75011 Paris - France

^[12] Hop La Pitie Salpetriere, AP HP, F-75013 Paris - France

^[13] CHU Pontchaillou, F-35000 Rennes - France

^[14] Hop Henri Mondor, AP HP, F-94010 Creteil - France

^[15] Viral Hepatitis Lab LIM 47, BR-01246903 Sao Paulo - Brazil

• Tipo de documento: Artigo Científico
• Fonte: WORLD JOURNAL OF GASTROENTEROLOGY; v. 22, n. 18, p. 4547-4558, MAY 14 2016.
• Citações Web of Science: 6

Resumo

AIM: To identify risk factors associated with survival in patients retransplanted for hepatitis C virus (HCV) recurrence and to apply a survival score to this population. METHODS: We retrospectively identified 108 patients retransplanted for HCV recurrence in eight European liver transplantation centers (seven in France, one in Spain). Data collection comprised clinical and laboratory variables, including virological and antiviral treatment data. We then analyzed the factors associated with survival in this population. A recently published score that predicts survival in retransplantation in patients with hepatitis C was applied. Because there are currently no uniform recommendations regarding selection of the best candidates for retransplantation in this setting, we also described the clinical characteristics of 164 patients not retransplanted, with F3, F4, or fibrosing cholestatic hepatitis (FCH) post-first graft presenting with hepatic decompensation. RESULTS: Overall retransplantation patient survival rates were 55%, 47%, and 43% at 3, 5, and 10 years, respectively. Patients who were retransplanted for advanced cirrhosis had survival rates of 59%, 52%, and 49% at 3, 5, and 10 years, while those retransplanted for FCH had survival rates of 34%, 29%, and 11%, respectively. Under multivariate analysis, and adjusting for the center effect and the occurrence of FCH, factors associated with better survival after retransplantation were: negative HCV viremia before retransplantation, antiviral therapy after retransplantation, non-genotype 1, a Model for End-stage Liver Disease (MELD) score < 25 when replaced on the waiting list, and a retransplantation donor age < 60 years. Although the numbers were small, in the context of the new antivirals era, we showed that outcomes in patients who underwent retransplantation with undetectable HCV viremia did not depend on donor age and MELD score. The Andres score was applied to 102 patients for whom all score variables were available, producing a mean score of 43.4 (SD = 6.6). Survival rates after the date of the first decompensation post-first liver transplantation (LT1) in the liver retransplantation (reLT) group (94 patients decompensated) at 3, 5, and 10 years were 62%, 59%, and 51%, respectively, among 78 retransplanted individuals with advanced cirrhosis, and 42%, 32%, and 16% among 16 retransplanted individuals with FCH. In the non-reLT group with hepatic decompensation, survival rates were 27%, 18%, and 9% at 3, 5, and 10 years, respectively (p < 0.0001). Compared with non-retransplanted patients, retransplanted patients were younger at LT1 (mean age 48 +/- 8 years compared to 53 +/- 9 years in the no reLT group, p < 0.0001), less likely to have human immunodeficiency virus (HIV) co-infection (4% vs 14% among no reLT patients, p = 0.005), more likely to have received corticosteroid bolus therapy after LT1 (25% in reLT vs 12% in the no reLT group, p = 0.01), and more likely to have presented with sustained virological response (SVR) after the first transplantation (20% in the reLT group vs 7% in the no reLT group, p = 0.028). CONCLUSION: antiviral therapy before and after retransplantation had a substantial impact on survival in the context of retransplantation for HCV recurrence, and with the new direct-acting antivirals now available, outcomes should be even better in the future. (AU)

• Processo FAPESP: 12/03895-6 - Fatores preditivos e escore de sobrevida em pacientes com Hepatite C submetidos a retransplante de fígado
• Beneficiário: Alice Tung Wan Song
• Modalidade de apoio: Bolsas no Exterior - Pesquisa