Retransplantation for graft failure in chronic hepatitis C infection: A good use of a scarce resource?

Table 1 Comparison of peer-reviewed studies on retransplantation outcome in patients with hepatitis C virus infection

Author	Design	Number with HCV infection	Outcome	Predictors
Database studies
Rosen et al[11]	UNOS database	HCV total 357	54% 5-yr survival	HCV associated with mortality (HR 1.3)
Watt et al[12]	UNOS database	HCV total 899	45% 5-yr survival	MELD > 25
Petellier et al[13]	SRTR database	HCV total 464	NA	HCV associated with mortality (HR 1.3)
Ghabril et al[14]	UNOS database	HCV total 1034	rOLT 90 d-1 yr: 44% 3-yr survival	MELD > 25
			rOLT > 1 yr: 59% 3-yr survival	Donor > 60
				Donor black
				WIT > 75 min
Rowe et al, current study	UK Transplant database	34 recurrent HCV	Recurrent HCV rOLT 5-yr graft survival 45%	None
		46 HCV	HCV rOLT other reasons HCV 5-yr graft survival 80%
Center-led studies
Roayaie et al[15]	Retrospective single center	HCV total 42	52% alive at 6 mo	Donor < 60
				PT < 16 s
Neff et al[16]	Retrospective single center	HCV total 22	50% 1-yr survival	Normal physical activity
Carmiel-Haggai et al[17]	Retrospective single center	47 recurrent HCV	37% 1-yr mortality	Donor > 60
		62 HCV		Cirrhosis FCH
McCashland et al[18]	Prospective multicenter	HCV total 43	3-yr survival 49%	MELD not predictive
Bahra et al[19]	Retrospective single center	18 recurrent HCV	Recurrent HCV rOLT 5-yr survival 59%	MELD > 25
		11 HCV	HCV rOLT other reasons 5-yr survival 84%	Bilirubin > 15 mg/dL
Ghabril et al[10]	Retrospective single center	25 recurrent HCV	63% 3-yr survival	Donor age > 60
		48 HCV		Recipient > 60

UNOS: United Network for Organ Sharing; SRTR: Scientific registry of transplant recipients; HCV: Hepatitis C virus; rOLT: Retransplantation; MELD: Model for end-stage liver disease; PT: Prothrombin time; FCH: Fibrosing cholestatic hepatitis; WIT: Warm ischemia time.

Table 2 Characteristics of those patients undergoing retransplatation (mean ± SD) n (%)

Characteristic	First graft failed due to		P-value
	Recurrent disease	Other reasons
n	34	46
Recipient age (yr)	50.0 ± 8.16	53.1 ± 8.14	0.090
Recipient blood group
O	11 (32.3)	18 (39.1)	0.800
A	16 (47.1)	18 (39.1)
B	4 (11.8)	7 (15.2)
AB	3 (8.8)	3 (6.5)
Recipient gender, male	27 (79.4)	33 (71.7)	0.400
Recipient height (cm)	173.3 ± 9.72	169.6 ± 9.94	0.090
Recipient weight (kg)	81.0 ± 13.93	77.6 ± 17.48	0.400
HCV group for first graft
HCV alone	25 (73.5)	24 (52.2)
HCV + HCC	3 (8.8)	16 (34.8)	0.030
HCV + ALD	6 (17.6)	6 (13.0)
MELD score	19.9 ± 5.08	22.1 ± 10.79	0.280
Year of first graft
1994-2000	23 (67.6)	22 (47.8)	0.080
2001-2007	11 (32.4)	24 (52.2)
Year of second graft
1994-1998	7 (20.6)	14 (30.4)	0.060
1999-2003	13 (38.2)	24 (52.2)
2004-2007	14 (41.2)	8 (17.4)
Cold ischemia time (h)	11.9 ± 2.61	9.7 ± 3.29	0.020
Hospitalization status, Outpatient	19 (55.9)	4 (8.7)	< 0.001
Time from first graft to second graft (yr)	2.8 ± 2.17	0.38 ± 1.03	< 0.001
Donor organ appearance, normal	28 (82.4)	40 (87.0)	0.600

SD: Standard deviation; HCC: Hepatocellular carcinoma; ALD: Alcoholic liver disease.

Table 3 Predictive factors for transplant survival following liver retransplantation for patients with hepatitis C virus infection

Variable	Category	n	Hazard ratio (95% CI)	P value
Recurrent disease	No	46	1
	Yes	34	0.92 (0.49-1.73)	0.8
Donor age (yr)	Linear	80	1.00 (0.98-1.03)	0.7
Donor blood group	O	43	1
	A, B, AB	37	0.91 (0.49-1.70)	0.8
Donor gender	Male	37	1
	Female	43	1.23 (0.66-2.29)	0.5
Donor height (cm)	Linear	80	0.98 (0.95-1.01)	0.3
Donor weight	Linear	80	0.98 (0.96-1.01)	0.2
Recipient age (yr)	Linear	80	0.99 (0.96-1.03)	0.6
Recipient blood group	O	29	1
	A, B, AB	51	1.00 (0.52-1.91)	0.99
Recipient gender	Male	60	1
	Female	20	1.38 (0.70-2.72)	0.4
Recipient height (cm)	Linear	80	0.98 (0.95-1.01)	0.1
Recipient weight (kg)	Linear	80	0.99 (0.98-1.02)	0.6
HCV group for first graft	HCV alone	49	1
	HCV + HCC	19	2.15 (1.07-4.30)	0.03
	HCV + ALD	12	1.13 (0.46-2.81)	0.8
MELD score	Linear	80	1.00 (0.96-1.05)	0.9
Year of first graft	Linear	80	1.04 (0.89-1.21)	0.6
Year of second graft	Linear	80	0.96 (0.87-1.06)	0.47
Cold ischemia time (h)	Linear	80	0.99 (0.92-1.06)	0.74
Hospitalization status	Outpatient	24	1
	Inpatient	56	1.36 (0.66-2.78)	0.4
Time from first to second graft (yr)	Linear	80	1.04 (0.89-1.21)	0.6
Donor organ appearance	Normal	68	1
	Abnormal	12	1.04 (0.44-2.47)	0.9

HCV: Hepatitis C virus; HCC: Hepatocellular carcinoma; MELD: Model for end-stage liver disease; ALD: Alcoholic liver disease.