Recurrent hepatitis C after liver transplant

Table 3 Risk factors studied for association with more severe hepatitis C virus recurrence

Factor	Evidence
Donor
Age > 40 yr	↑↑↑
Living donor	↔
Split liver	↔
DCD	↔
HCV+	↔
Macrovesicular steatosis > 30%	↑↓
IRI	↑↓
IL28B “CC” genotype	↑↓
Virus
HCV genotype 1	↑
High pre-transplant HCV RNA	↑
HCV RNA 4 mo post LT ≥ 1 × 109 mEq/mL	↑↑
CMV viremia	↑↑↑
HIV coinfection	↑↑
Recipient
Female sex	↑↑
African American D/R mismatch	↑↑
African American D/R match	↔
Metabolic syndrome1	↑
IL28B non-“CC” genotype	↑
Immunosuppression
Pulsed corticosteroids for American College of Rheumatology	↑↑↑
Tacrolimus (vs CsA)	↑↓
Sirolimus	↑
Thymoglobulin	↔
Basiliximab	↔
OKT3	↑

¹Metabolic syndrome defined by ATP-III criteria 1 yr post liver transplantation (LT)[37], homeostasis model assessment-estimated insulin resistance > 2.5 4 mo post LT[46], or hepatic steatosis ≥ 5% on an index liver allograft biopsy 1 yr post-LT[47]. ↑: Evidence of increased risk; ↔: Evidence of no increased risk; ↑↓: Indeterminate risk; DCD: Donation after cardiac death; HCV: Hepatitis C virus; CMV: Cytomegalovirus; HIV: Human immunodeficiency virus; CsA: Cyclosporin A; OKT3: Muromonab-CD3; IRI: Ischemia reperfusion injury.