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It has been suggested that recurrent hepatitis C infection may bc associated with particularly poor outcome following hepatic retransplantation (Transplantation 1996, 62: 1773) AIMS: To determine the prevalence of HCV and predictors of outcome in patients undergoing ReTx. Methods: We analyzed the UNOS Registry data of 1539 adults undergoing ReTx between l/90-1/96, 357 (23%) were HCV positive Results: The prevalence of HCV infection increased significantly 6.5%, 11%, 19.5%, 25%. 36%, 38.4%, respectively for each year since 1990 (p<.00011). Comparing the HCV positive vs negative groups. There were no significant differences with regards to age (48 vs 45 yrs), time to ReTx (229 vs 198 days), total bilirubin at time of ReTx (17.6 vs 17.1 mg/dL), PT (17.9 vs 17.4 sec), creatinine (2.3 vs 2.2), albumin (2.2 vs 2.l), UNOS status mix (60% vs 62% status 1) or cause of graft failure (% with primary nonfunction) However, Kaplan-Mar analysts demonstrated significantly diminished patient survival in the HCV positive group (p = .0038, log-rank test, Odds ratio I:36) Analyses of the subgroup of HCV + pts retransplanted for non-PNF causes identified total bilirubin and serum creatinine immediately prior to ReTx as prognostically significant.
Conclusions: HCV infection is an independent risk factor for death following ReTx. However, acceptable patient survival is attainable if ReTx occurs prior to development of severe hyperbilrubinenia and renal failure. Although the increasing prevalence of HCV may reflect unproved serologic testing; it raises concern about the cumulative contribution of recurrent HCV to graft failure.