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Early high peak hepatitis C viral load levels independently predict hepatitis C–related liver failure post–liver transplantation

  1. Nicholas A. Shackel1,2,3,†,‡,*,
  2. Jade Jamias1,3,†,
  3. Wassim Rahman1,3,
  4. Emilia Prakoso1,2,3,
  5. Simone I. Strasser1,3,
  6. David J. Koorey1,3,
  7. Michael D. Crawford1,
  8. Deborah J. Verran1,
  9. James Gallagher1,
  10. Geoffrey W. McCaughan1,2,3

Article first published online: 26 JUN 2009

DOI: 10.1002/lt.21747

Issue

Liver Transplantation

Liver Transplantation

Volume 15, Issue 7, pages 709–718, July 2009

Additional Information

How to Cite

Shackel, N. A., Jamias, J., Rahman, W., Prakoso, E., Strasser, S. I., Koorey, D. J., Crawford, M. D., Verran, D. J., Gallagher, J. and McCaughan, G. W. (2009), Early high peak hepatitis C viral load levels independently predict hepatitis C–related liver failure post–liver transplantation. Liver Transplantation, 15: 709–718. doi: 10.1002/lt.21747

Author Information

  1. 1

    A.W. Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia

  2. 2

    Centenary Institute of Cancer Medicine and Cell Biology, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia

  3. 3

    Centre for Clinical Research Excellence To Improve Outcomes in Chronic Liver Disease, University of Sydney, Sydney, Australia

  1. †

    These authors contributed equally to this study.

  2. ‡

    Telephone: +1 61 2 95656286; FAX: +61 2 95656101

*Royal Prince Alfred Hospital, Locked Bag No. 6, Newtown, Sydney, New South Wales, Australia 2050

Publication History

  1. Issue published online: 26 JUN 2009
  2. Article first published online: 26 JUN 2009
  3. Manuscript Accepted: 29 DEC 2008
  4. Manuscript Received: 25 AUG 2008

Funded by

  • National Health and Medical Research Council Clinical Center of Research Excellence Grant. Grant Number: 219282
  • Roche CellCept Australia Research Grant

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Abstract

The aim of this study was to examine the importance of the serum hepatitis C viral load within the first year post–liver transplant in determining posttransplant survival. A retrospective analysis of 118 consecutive hepatitis C virus–positive liver transplant recipients who received an allograft from January 1997 to September 2005 was undertaken with a median duration of follow-up of 32.4 months. Univariate and multivariate analyses were used to examine the effects of recipient, donor, surgical, and viral factors on posttransplant outcomes. A total of 620 viral load estimations were undertaken in the first 12 months following transplantation. Patient and graft survival rates at 1, 3, and 5 years were 87.8%, 79.9%, and 70.1% and 87.0%, 79.2%, and 68.2%, respectively. According to multivariate analysis, a peak viral load ≥ 107 IU/mL (P = 0.004; hazard ratio, 8.68; 95% confidence interval, 2.04–37.02) and exposure to antirejection therapy (P = 0.05; hazard ratio, 2.26; 95% confidence interval, 1.01–5.38) were both independent predictors of diminished patient and graft survival and hepatitis C–related allograft failure. The only other independent predictor of hepatitis C virus–related outcome after transplant was azathioprine use, which was associated with improved outcomes (P = 0.04; hazard ratio, 0.25; 95% confidence interval, 0.07–0.91). A peak viral load in the first year after transplant of >108, 107 to 108, and <107 IU/mL was associated with a mean survival of 11.8, 70.6, and 89.1 months respectively (P ≤ 0.03). The results emphasize the importance of high viral loads in the early posttransplant period as an independent predictor of recipient outcomes. Liver Transpl 15:709–718, 2009. © 2009 AASLD.

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