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Liver Transplantation and Surgery, Vol 3, 130-136,
ORIGINAL ARTICLES
Retransplantation for recurrent hepatitis C
PA Sheiner, LK Schluger, S Emre, SN Thung, JY Lau, SR Guy, ME Schwartz
and CM Miller
Department of Surgery, Mount Sinai Medical Center of the City University
of New York, New York, USA.
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.
table Of Contents
Copyright © 1997 by American Association for the Study of Liver Diseases
and International Liver Transplantation Society
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