These authors contributed equally to this study.
Early high peak hepatitis C viral load levels independently predict hepatitis C–related liver failure post–liver transplantation
Article first published online: 26 JUN 2009
Copyright © 2009 American Association for the Study of Liver Diseases
Volume 15, Issue 7, pages 709–718, July 2009
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 Transpl, 15: 709–718. doi: 10.1002/lt.21747
- Issue published online: 26 JUN 2009
- Article first published online: 26 JUN 2009
- Manuscript Accepted: 29 DEC 2008
- Manuscript Received: 25 AUG 2008
- National Health and Medical Research Council Clinical Center of Research Excellence Grant. Grant Number: 219282
- Roche CellCept Australia Research Grant
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.