Predictors of graft and patient survival in hepatitis C virus (HCV) recipients: model to predict HCV cirrhosis after liver transplantation

Transplantation. 2007 Jul 15;84(1):56-63. doi: 10.1097/01.tp.0000267916.36343.ca.

Abstract

Background: Hepatitis C virus (HCV) recurrence after liver transplantation (LT) is almost universal, but the natural history of recurrent HCV in the allograft is highly variable. Our study had two aims: 1) to assess the impact of different pre- and postLT factors on graft and patient survival in HCV transplant recipients and 2) to create a model which may predict the patients at risk for HCV-related graft cirrhosis at 5 years postLT.

Methods: A total of 168 LTs were considered for this study. Univariate and multivariate Cox proportional hazards regression model was used, as well as logistic regression analysis to create a model of prediction of HCV cirrhosis within 5 years after LT.

Results: Predictive factors for both decreased graft and patient survival included patients recently transplanted (2000-2004), induction without azathioprine, short-term therapy with mycophenolate mofetil and prednisone (< or =6 months), presence of early cholestasis, histologically proven early recurrence of hepatitis C. Recipient human leukocyte antigen DR3 positivity, presence of early cholestasis, and donor age >50 years were identified as independent predictors of graft cirrhosis within 5 years. A predictive model was established in order to calculate at 6 months a risk score for graft HCV cirrhosis within 5 years postLT using a formula that included the identified independent predictors. The area under receiver operating characteristic curve was 0.83, indicating a good ability to predict medium-term HCV allograft cirrhosis.

Conclusion: This model may be a useful tool for better identifying high-risk HCV patients who should be selected for early initiation of antiviral therapy.

MeSH terms

  • Cohort Studies
  • Drug Administration Schedule
  • Female
  • Graft Rejection / epidemiology
  • Graft Survival*
  • HLA-DR3 Antigen / blood
  • Hepatitis C / complications*
  • Hepatitis C / surgery*
  • Humans
  • Immunosuppressive Agents / administration & dosage
  • Immunosuppressive Agents / therapeutic use
  • Incidence
  • Liver Cirrhosis / virology*
  • Liver Transplantation* / mortality
  • Male
  • Middle Aged
  • Models, Theoretical*
  • Mycophenolic Acid / administration & dosage
  • Mycophenolic Acid / analogs & derivatives
  • Mycophenolic Acid / therapeutic use
  • Postoperative Complications
  • Postoperative Period
  • Predictive Value of Tests
  • Prednisone / administration & dosage
  • Prednisone / therapeutic use
  • Recurrence
  • Retrospective Studies
  • Risk Assessment
  • Survival Analysis
  • Time Factors

Substances

  • HLA-DR3 Antigen
  • Immunosuppressive Agents
  • Mycophenolic Acid
  • Prednisone