Outcomes for Patients with Hepatitis C Virus after Liver Transplantation in Korea

Abstract

Hepatitis C virus (HCV)-related liver disease is the most common indication for liver transplantation (LT) in Western countries, whereas HCV LT is rare in Korea. We conducted a survey of HCV RNA-positive patients who underwent LT and investigated the prognostic factors for patient survival and the effects of immunosuppression. To accomplish this, we retrospectively reviewed the multicenter records of 192 HCV RNA-positive patients who underwent LT. The 1-, 3-, and 5-year overall survival rates were 78.8%, 75.3%, and 73.1%, respectively. Excluding cases of hospital mortality (n=23), 169 patients were evaluated. Most patients were genotype 1 (n=111, 65.7%) or genotype 2 (n=42, 24.9%). The proportion of living donors for LT (n=135, 79.9%) was higher than that of deceased donors (DDLT; n=34, 20.1%). The median donor and recipient ages were 32 and 56 years, respectively. Twenty-eight patients (16.6%) died during the observation period, while 75 underwent universal prophylaxis and 15 received preemptive therapy. HCV recurrence was detected in 97 patients. Recipients who were older than 60, received DDLT, used cyclosporine, or suffered acute rejection had lower rates of survival. Acute rejection was closely associated with a lack of induction therapy, cyclosporine use, and universal prophylaxis after transplantation. The careful avoidance of acute rejection in the post-transplant period through adequate use of tacrolimus is a preferable strategy that increases patient survival following liver transplantation.