Long-Term Liver Transplant Survival

A new study on the effect of donor age on survival and recurrence of hepatitis C after liver transplantation found that although it influenced short-term survival, it had no long-term effect.

Patients who undergo liver transplantation for cirrhosis due to hepatitis C are invariably re-infected with the virus after transplantation. When the disease recurs, it often takes a more rapid and aggressive course. Survival rates of these patients appear to be worsening over the past few years.

In a study of 195 transplantations due to end-stage cirrhosis related to hepatitis C, researchers examined the impact of donor age, immunosuppression, and other factors on short- and long-term survival. Donor age was not associated with the development of severe fibrosis, and patients receiving treatment with maintenance steroids and/or azathioprine tended not to develop severe fibrosis. Hepatitis C, even if later discontinued, was an independent factor associated with worse fibrosis. Although several studies have suggested that less immunosuppression may be a viable strategy in minimizing progression of hepatitis C post-transplant, the authors found the situation to be more complex. They state that "the rapid withdrawal of steroids prevalent in recent years may have allowed an early reconstitution of the immune system and its exposure to a large number of HCV (hepatitis C virus)-infected liver cells, leading to immune mediated severe liver damage and thus to more frequent and severe forms of HCV recurrence.”

Another study on 10-year liver transplant survival found that alcohol relapse adversely affected survival rates only after 10 years. Both studies appeared in the April 2005 issue of Liver Transplantation, published by John Wiley, and are available on the company's website (www.interscience.wiley.com/journal/livertransplantation).





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