We were pleased by the comments of Bralet et al.1 relating to our recent publication in HEPATOLOGY and detailing results from their institution. The findings of the 2 studies are quite similar. Firstly, hereditary hemochromatosis is an uncommon indication for liver transplantation. Despite not reporting the total number of liver transplants performed in their institution, it is safe to assume that these 5 patients presented in their correspondence represent only a small proportion of their total transplant population. Secondly, the absence of evidence of liver iron reaccumulation after a lengthy follow-up period (median, 12.2 years) suggests an important role for the liver in contributing to the pathophysiology of iron overload in hereditary hemochromatosis.
In contrast to our study, the overall survival of the patients reported by Bralet et al. is very good. It should be emphasized however, that the most outstanding variable predicting death in our cohort was the presence of a hepatocellular carcinoma outside the Mazzaferro criteria. The tumor border is not clearly defined in the patients reported by Bralet et al. However, their chemotherapy protocol is deserving of further study if those tumors were outside the current guidelines regarding transplantation in patients with hepatocellular carcinoma.