Post-liver transplant survival in Hep C is improving

Dr Jacqueline O'Leary and colleagues from Texas, USA found outcomes after orthotopic liver transplantation for chronic Hepatitis C have been reported to be worsening over the last 2 decades.

The team analyzed our center's experience over 15 years to identify trends in post-orthotopic liver transplantation survival in patients with and without Hepatitis C virus infection.

Patient survival and graft survival among 1901 adult primary orthotopic liver transplantation recipients who survived more than 90 days from 1991 to 2006 at the Baylor Regional Transplant Institute were evaluated by Kaplan-Meier analysis.
 
Those with or without Hepatitis C virus infection were analyzed by era.

Era 1 included 473 and spanned from 1991 to 1994, whereas era 2 had 421 patients and went from 1995 to 1998.

Era 3 spanned from 1999 to 2002 and included 498 patients, with 512 patients in Era 4 evaluated from 2003 to 2006.

The team assessed differences in eras with disparate survivals by univariate and multivariable analysis.

Overall, patient survival and graft survival were significantly lower among Hepatitis C virus infection recipients compared to those without Hepatitis C virus infection.

This difference was dependent on the era of transplantation, with progressive improvement in Hepatitis C virus patient  and graft survival in sequential eras.

The researchers found several factors accounted for this improvement, notably better selection of hepatocellular carcinoma patients and fewer late cytomegalovirus infections.

The team noted that improvement occurred despite an increase in the ages of both donors and recipients.

Dr O'Leary's team concluded, “Posttransplant survival after orthotopic liver transplantation for chronic Hepatitis C has improved significantly over the last 15 years.”

“Despite demographic changes in patients and grafts that have been previously shown to impair survival.”

“A major reason for this improvement is better selection of patients with concurrent hepatocellular carcinoma and fewer late cytomegalovirus infections, although other factors may play a role as well.”

http://www.gastrohep.com/news/news.asp?id=106420

Risk factors for early hepatic artery thrombosis after transplantation

31 March 2009

Dr Bekker and colleagues from the Netherlands conducted a systematic review to identify the incidence, risk factors and outcome of early hepatic artery thrombosis after liver transplantation.

The team searched studies identified from databases including MEDLINE, EMBASE, Science Citation Index, and references of identified studies.

The team identified 71 studies out of 999 screened abstracts as eligible for this systematic review.

The team found that the incidence of hepatic artery thrombosis was 4%.

In children, the incidence of hepatic artery thrombosis was 8%, and 3% in adults.

Doppler ultrasound screening  protocols varied from 'no routine' to 'three times a day.'

The median time to detection was at day 7.

The team noted that the overall retransplantation rate was 53%, and was higher in children than in adults.

The overall mortality rate of patients with hepatic artery thrombosis was 33%.

The researchers found that mortality in adults was higher than in children.

The reported risk factors for hepatic artery thrombosis included cytomegalovirus mismatch, and retransplantation.

Arterial conduits, prolonged operation time, low recipient weight, variant arterial anatomy, and low volume transplantation centers were also risk factors for hepatic artery thrombosis.

Hepatic artery thrombosis is associated with significant graft loss and mortality.

Dr Bekker’s team concluded, “Uniform definitions of hepatic artery thrombosis and uniform treatment modalities are obligatory to confirm these results and to obtain a better understanding of this disastrous complication.”