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• W2079728952 abstract "Hepatitis C virus (HCV) infection recurs universally after liver transplantation (LT) and fibrosis progression is accelerated in the graft. Retransplantation (RT) is the only therapeutic option to achieve long-term survival in patients with decompensated cirrhosis after LT. Patient and graft survival rates after RT are inferior to those after primary LT. It is generally accepted that severe hepatitis C recurrence (cholestatic hepatitis) and forms with rapid fibrosis progression have a poor survival after RT. However, it is not clear whether rapid fibrosis progression in the first graft will be followed by the same rate of fibrosis progression in the second graft. The use of prognostic scores as screening tools has shown an improvement in survival in HCV-infected patients after RT, reaching similar survival rates as those obtained in non HCV-infected patients. Moreover, these scores can identify candidates with a high risk of mortality in whom the use of a new organ would be unreasonable. Prevention of severe hepatitis C recurrence could be the first step to avoid RT. Thus, antiviral treatment on the waiting list (if possible) and early identification and treatment of patients with severe hepatitis C recurrence may be a good strategy to avoid RT. In addition, active management of factors which can accelerate fibrosis progression (donor age, post-transplant diabetes, high dose of corticosteroids) might reduce the incidence of severe forms of hepatitis C recurrence. Hepatitis C virus (HCV) infection recurs universally after liver transplantation (LT) and fibrosis progression is accelerated in the graft. Retransplantation (RT) is the only therapeutic option to achieve long-term survival in patients with decompensated cirrhosis after LT. Patient and graft survival rates after RT are inferior to those after primary LT. It is generally accepted that severe hepatitis C recurrence (cholestatic hepatitis) and forms with rapid fibrosis progression have a poor survival after RT. However, it is not clear whether rapid fibrosis progression in the first graft will be followed by the same rate of fibrosis progression in the second graft. The use of prognostic scores as screening tools has shown an improvement in survival in HCV-infected patients after RT, reaching similar survival rates as those obtained in non HCV-infected patients. Moreover, these scores can identify candidates with a high risk of mortality in whom the use of a new organ would be unreasonable. Prevention of severe hepatitis C recurrence could be the first step to avoid RT. Thus, antiviral treatment on the waiting list (if possible) and early identification and treatment of patients with severe hepatitis C recurrence may be a good strategy to avoid RT. In addition, active management of factors which can accelerate fibrosis progression (donor age, post-transplant diabetes, high dose of corticosteroids) might reduce the incidence of severe forms of hepatitis C recurrence. Hepatitis C virus (HCV) infection has become the most common cause of cirrhosis and hepatocellular carcinoma in the Western world. End-stage liver disease due to HCV-infection is the leading indication for liver transplantation (LT). Unfortunately, HCV infection recurs universally after LT in patients with detectable HCV RNA at the time of transplantation [[1]Garcia-Retortillo M. Forns X. Feliu A. Moitinho E. Costa J. Navasa M. et al.Hepatitis C virus kinetics during and immediately after liver transplantation.Hepatology. 2002; 35: 680-687Crossref PubMed Scopus (442) Google Scholar]. Fibrosis progression, cirrhosis development, and clinical decompensation occur more rapidly in HCV-infected liver transplant recipients than in immunocompetent patients [[2]Berenguer M. Prieto M. Rayon J.M. Mora J. Pastor M. Ortiz V. et al.Natural history of clinically compensated hepatitis C virus-related graft cirrhosis after liver transplantation.Hepatology. 2000; 32: 852-858Crossref PubMed Scopus (489) Google Scholar]: whereas the median interval from infection to cirrhosis is around 9.5 years in LT recipients, the same interval is around 30 years in immunocompetent patients. Cirrhosis develops in around one-third of HCV-infected patients during the first 5 years after LT [[3]Prieto M. Berenguer M. Rayon J.M. Cordoba J. Arguello L. Carrasco D. et al.High incidence of allograft cirrhosis in hepatitis C virus genotype 1b infection following transplantation: relationship with rejection episodes.Hepatology. 1999; 29: 250-256Crossref PubMed Scopus (485) Google Scholar]. In addition, a small number of individuals (2–5%) develop fibrosing cholestatic hepatitis (FCH), a severe form of hepatitis C recurrence characterized by cholestatic hepatitis, hepatocyte ballooning, and perisinusoidal fibrosis leading to graft failure within a few months after LT [[4]Gane E.J. The natural history of recurrent hepatitis C and what influences this.Liver Transpl. 2008; 14: S36-S44Crossref PubMed Scopus (220) Google Scholar]. As a consequence, hepatitis C recurrence is the primary cause of graft loss and reduction in patient survival in transplant programs in which HCV-infection is the main indication for LT [[5]Forman L.M. Lewis J.D. Berlin J.A. Feldman H.I. Lucey M.R. The association between hepatitis C infection and survival after orthotopic liver transplantation.Gastroenterology. 2002; 122: 889-896Abstract Full Text Full Text PDF PubMed Scopus (944) Google Scholar]. The prognosis of patients once graft cirrhosis is established is poor and when graft failure occurs, retransplantation (RT) is the only therapeutic option offering a chance for long-term survival. Berenguer et al. [[2]Berenguer M. Prieto M. Rayon J.M. Mora J. Pastor M. Ortiz V. et al.Natural history of clinically compensated hepatitis C virus-related graft cirrhosis after liver transplantation.Hepatology. 2000; 32: 852-858Crossref PubMed Scopus (489) Google Scholar] found that patients with clinically compensated cirrhosis achieved a 1-year survival rate of 74%. However, once patients developed clinical decompensation, survival decreased to 41% at 1 year and approximately 10% at 3 years. It is generally accepted that progression to cirrhosis is faster after RT than after primary LT, particularly in patients with severe hepatitis C recurrence (cholestatic hepatitis and graft failure within the first year). Patient and graft survival rates after RT are inferior to those after primary LT and are associated with a greater cost. Pelletier et al. [[6]Pelletier S.J. Schaubel D.E. Punch J.D. Wolfe R.A. Port F.K. Merion R.M. Hepatitis C is a risk factor for death after liver retransplantation.Liver Transpl. 2005; 11: 434-440Crossref PubMed Scopus (74) Google Scholar] demonstrated a 30% increase in mortality for HCV-infected RT recipients (20% for HCV-infected primary LT [[7]Velidedeoglu E. Mange K.C. Frank A. Abt P. Desai N.M. Markmann J.W. et al.Factors differentially correlated with the outcome of liver transplantation in hcv+ and HCV− recipients.Transplantation. 2004; 77: 1834-1842Crossref PubMed Scopus (89) Google Scholar]). Table 1 shows the liver graft survival rate after LT and after RT between 1984 and 2008 in Spain. Most deaths after RT are, however, not related to hepatitis C recurrence but to post-operative complications such as bacterial infections. Patients with a more severe liver disease and poor preoperative clinical conditions have the highest mortality following RT [[8]Biggins S.W. Terrault N.A. Should HCV-related cirrhosis be a contraindication for retransplantation?.Liver Transpl. 2003; 9: 236-238Crossref PubMed Scopus (26) Google Scholar]. Despite liver fibrosis progression after primary LT has been well characterized [[9]Yilmaz N. Shiffman M.L. Stravitz R.T. Sterling R.K. Luketic V.A. Sanyal A.J. et al.A prospective evaluation of fibrosis progression in patients with recurrent hepatitis C virus following liver transplantation.Liver Transpl. 2007; 13: 975-983Crossref PubMed Scopus (120) Google Scholar], studies assessing this subject after RT are insufficient to draw any solid conclusions [10Berenguer M. Prieto M. Palau A. Rayon J.M. Carrasco D. Juan F.S. et al.Severe recurrent hepatitis C after liver retransplantation for hepatitis C virus-related graft cirrhosis.Liver Transpl. 2003; 9: 228-235Crossref PubMed Scopus (101) Google Scholar, 11Carmiel-Haggai M. Fiel M.I. Gaddipati H.C. Abittan C. Hossain S. Roayaie S. et al.Recurrent hepatitis C after retransplantation: factors affecting graft and patient outcome.Liver Transpl. 2005; 11: 1567-1573Crossref PubMed Scopus (42) Google Scholar]. Moreover, other facts may influence the evolution of HCV-infection after RT. Recent studies have suggested that the grafting of a new liver may produce significant changes in the HCV quasispecies and may thereby change the severity of the disease and the susceptibility to antiviral treatment [12Feliu A. Gay E. Garcia-Retortillo M. Saiz J.C. Forns X. Evolution of hepatitis C virus quasispecies immediately following liver transplantation.Liver Transpl. 2004; 10: 1131-1139Crossref PubMed Scopus (54) Google Scholar, 13Feliu A. Carrion J.A. Massaguer A. Martinez-Bauer E. Garcia-Retortillo M. Gonzalez P. et al.Sensitivity to antiviral therapy may change after liver transplantation in patients with chronic hepatitis C virus infection.J Viral Hepat. 2006; 13: 544-551Crossref PubMed Scopus (15) Google Scholar].Table 1Graft survival of transplanted (LT) and retransplanted (RT) patients from 1984 to 2008 in Spain. Database from “Organización Nacional de Trasplante” (ONT) [14]Organización Nacional de Trasplante (ONT); 2009. Available from: http://www.ont.es.Google Scholar.LT, liver transplantation; RT, retransplantation; HR, hazard ratio; 95% CI, 95% confidence interval. Open table in a new tab LT, liver transplantation; RT, retransplantation; HR, hazard ratio; 95% CI, 95% confidence interval. Among patients with multiple RTs, a recent analysis of the Spanish Transplant Organization showed a worse outcome in individuals with more than one RT [[14]Organización Nacional de Trasplante (ONT); 2009. Available from: http://www.ont.es.Google Scholar] (Table 1). Multivariate analysis demonstrated a significantly higher risk of mortality in patients who received a second [HR: 1.53 (95% IC: 1.38–1.7) p <0.01] or third graft [HR: 1.85 (95% IC: 1.4–2.4) p <0.01] as compared to the first transplant [[15]McCashland T.M. Retransplantation for recurrent hepatitis C: positive aspects.Liver Transpl. 2003; 9: S67-S72Crossref PubMed Scopus (29) Google Scholar]. However, Akpinar et al. [[16]Akpinar E. Selvaggi G. Levi D. Moon J. Nishida S. Island E. et al.Liver retransplantation of more than two grafts for recurrent failure.Transplantation. 2009; 88: 884-890Crossref PubMed Scopus (29) Google Scholar], evaluated 2527 LT between 1987 and 2008. Two hundred and thirty-five (9%) patients received two grafts; 32 (1.2%) three; five (0.2%) four; and two (0.01%) five grafts. Patients who underwent more than one RT had a survival rate of 72%, 56%, and 50% at 1, 5, and 10 years, respectively. There were no statistically significant differences in survival between these patients and those who underwent one RT, concluding that multiple RT can be safely performed. The main causes of liver graft failure are primary non-function (PNF), hepatic artery thrombosis (HAT), chronic rejection, and recurrence of viral or autoimmune disease. RT is performed at different times depending on the etiology of graft failure: PNF requires RT during the first days, whereas HAT may result in urgent or delayed RT (the latter when secondary ischemic cholangitis is the main complication). Chronic rejection and recurrence of viral or autoimmune disease are indications of elective RT. In general, there are no concerns regarding the use of a liver graft for RT in emergency situations (such as PNF or HAT) but elective RT (particularly for HCV recurrence) is much more controversial. Whereas some studies do not clearly identify HCV recurrence as an independent predictive factor of mortality after RT [17Doyle H.R. Morelli F. McMichael J. Doria C. Aldrighetti L. Starzl T.E. et al.Hepatic retransplantation – an analysis of risk factors associated with outcome.Transplantation. 1996; 61: 1499-1505Crossref PubMed Scopus (138) Google Scholar, 18Wong T. Devlin J. Rolando N. Heaton N. Williams R. Clinical characteristics affecting the outcome of liver retransplantation.Transplantation. 1997; 64: 878-882Crossref PubMed Scopus (83) Google Scholar, 19Markmann J.F. Markowitz J.S. Yersiz H. Morrisey M. Farmer D.G. Farmer D.A. et al.Long-term survival after retransplantation of the liver.Ann Surg. 1997; 226: 408-418Crossref PubMed Scopus (187) Google Scholar, 20Markmann J.F. Gornbein J. Markowitz J.S. Levy M.F. Klintmalm G.B. Yersiz H. et al.A simple model to estimate survival after retransplantation of the liver.Transplantation. 1999; 67: 422-430Crossref PubMed Scopus (94) Google Scholar, 21Ghobrial R.M. Gornbein J. Steadman R. Danino N. Markmann J.F. Holt C. et al.Pretransplant model to predict posttransplant survival in liver transplant patients.Ann Surg. 2002; 236: 315-322Crossref PubMed Scopus (146) Google Scholar, 22Azoulay D. Linhares M.M. Huguet E. Delvart V. Castaing D. Adam R. et al.Decision for retransplantation of the liver: an experience- and cost-based analysis.Ann Surg. 2002; 236: 713-721Crossref PubMed Scopus (179) Google Scholar], other recent studies [6Pelletier S.J. Schaubel D.E. Punch J.D. Wolfe R.A. Port F.K. Merion R.M. Hepatitis C is a risk factor for death after liver retransplantation.Liver Transpl. 2005; 11: 434-440Crossref PubMed Scopus (74) Google Scholar, 23Yoo H.Y. Maheshwari A. Thuluvath P.J. Retransplantation of liver: primary graft nonfunction and hepatitis C virus are associated with worse outcome.Liver Transpl. 2003; 9: 897-904Crossref PubMed Scopus (75) Google Scholar, 24Roayaie S. Schiano T.D. Thung S.N. Emre S.H. Fishbein T.M. Miller C.M. et al.Results of retransplantation for recurrent hepatitis C.Hepatology. 2003; 38: 1428-1436Crossref PubMed Scopus (77) Google Scholar, 25Neff G.W. O’Brien C.B. Nery J. Shire N.J. Nishida S. delaGarza J. et al.Factors that identify survival after liver retransplantation for allograft failure caused by recurrent hepatitis C infection.Liver Transpl. 2004; 10: 1497-1503Crossref PubMed Scopus (62) Google Scholar, 26Yao F.Y. Saab S. Bass N.M. Hirose R. Ly D. Terrault N. et al.Prediction of survival after liver retransplantation for late graft failure based on preoperative prognostic scores.Hepatology. 2004; 39: 230-238Crossref PubMed Scopus (91) Google Scholar] seem to indicate a poorer prognosis in RT of HCV-infected patients (Table 2, Table 3).Table 2Studies and predictive models in urgent and elective RT.LT, liver transplantation; RT, retransplantation; HCV, hepatitis C recurrence; HAT, hepatic artery thrombosis; PNF, primary non-function; MV, mechanical ventilation; ELTR, European Liver Transplant Registry; SRTR, Scientific Registry of Transplant Recipients database; y, years; d, days; h, hours; m, minutes; R, risk score; INR, international normalized ratio; UNOS (United Network for Organ Sharing) status, [1 (intensive care unit-bound), 2 (hospitalized), 3 (medical care), 4 (stable a thome)]. HR, hazard ratio; 95% CI, 95% confidence interval. (*) Liver grafts.The studies identifying HCV-infection as a risk factor of mortality on multivariate analysis are marked with a star. Open table in a new tab Table 3Studies and predictive models for RT (excluding patients with graft failure by PNF).LT, liver transplantation; RT, retransplantation; HCV, hepatitis C recurrence; PNF, primary non-function; RI, retransplant interval; UNOS, United Network for Organ Sharing; SRTR, Scientific Registry of Transplant Recipients database; CTP, Child–Turcotte-Pugh; MELD, model for end-stage liver disease; ICU, intensive care unit; RTDRI, Retransplant Donor Risk Index; y, years; m, months; d, days; INR, international normalized ratio. DRI (Donor Risk Index), exp [(0.154 if 40⩽ age <50) + (0.274 if 50 ⩽ age < 60) + (0.424 if 60⩽ age <70) + (0.501 if 70 ⩽age) + (0.079 if COD = anoxia) + (0.145 if COD = CVA) + (0.184 if COD = other) + (0.176 if race = African-American) + (0.126 if race = other) + (0.411 if DCD) + (0.422 if partial/split) + (0.066 ((170 − height)/10)) + (0.105 if regional share) + (0.244 if national share) + (0.010 × cold time)].The studies identifying HCV-infection as a risk factor of mortality on multivariate analysis are marked with a star. Open table in a new tab LT, liver transplantation; RT, retransplantation; HCV, hepatitis C recurrence; HAT, hepatic artery thrombosis; PNF, primary non-function; MV, mechanical ventilation; ELTR, European Liver Transplant Registry; SRTR, Scientific Registry of Transplant Recipients database; y, years; d, days; h, hours; m, minutes; R, risk score; INR, international normalized ratio; UNOS (United Network for Organ Sharing) status, [1 (intensive care unit-bound), 2 (hospitalized), 3 (medical care), 4 (stable a thome)]. HR, hazard ratio; 95% CI, 95% confidence interval. (*) Liver grafts. The studies identifying HCV-infection as a risk factor of mortality on multivariate analysis are marked with a star. LT, liver transplantation; RT, retransplantation; HCV, hepatitis C recurrence; PNF, primary non-function; RI, retransplant interval; UNOS, United Network for Organ Sharing; SRTR, Scientific Registry of Transplant Recipients database; CTP, Child–Turcotte-Pugh; MELD, model for end-stage liver disease; ICU, intensive care unit; RTDRI, Retransplant Donor Risk Index; y, years; m, months; d, days; INR, international normalized ratio. DRI (Donor Risk Index), exp [(0.154 if 40⩽ age <50) + (0.274 if 50 ⩽ age < 60) + (0.424 if 60⩽ age <70) + (0.501 if 70 ⩽age) + (0.079 if COD = anoxia) + (0.145 if COD = CVA) + (0.184 if COD = other) + (0.176 if race = African-American) + (0.126 if race = other) + (0.411 if DCD) + (0.422 if partial/split) + (0.066 ((170 − height)/10)) + (0.105 if regional share) + (0.244 if national share) + (0.010 × cold time)]. The studies identifying HCV-infection as a risk factor of mortality on multivariate analysis are marked with a star. Studies evaluating early post-transplant variables did not find HCV-infection to be an independent predictor of mortality after RT [17Doyle H.R. Morelli F. McMichael J. Doria C. Aldrighetti L. Starzl T.E. et al.Hepatic retransplantation – an analysis of risk factors associated with outcome.Transplantation. 1996; 61: 1499-1505Crossref PubMed Scopus (138) Google Scholar, 18Wong T. Devlin J. Rolando N. Heaton N. Williams R. Clinical characteristics affecting the outcome of liver retransplantation.Transplantation. 1997; 64: 878-882Crossref PubMed Scopus (83) Google Scholar, 19Markmann J.F. Markowitz J.S. Yersiz H. Morrisey M. Farmer D.G. Farmer D.A. et al.Long-term survival after retransplantation of the liver.Ann Surg. 1997; 226: 408-418Crossref PubMed Scopus (187) Google Scholar, 20Markmann J.F. Gornbein J. Markowitz J.S. Levy M.F. Klintmalm G.B. Yersiz H. et al.A simple model to estimate survival after retransplantation of the liver.Transplantation. 1999; 67: 422-430Crossref PubMed Scopus (94) Google Scholar, 21Ghobrial R.M. Gornbein J. Steadman R. Danino N. Markmann J.F. Holt C. et al.Pretransplant model to predict posttransplant survival in liver transplant patients.Ann Surg. 2002; 236: 315-322Crossref PubMed Scopus (146) Google Scholar, 22Azoulay D. Linhares M.M. Huguet E. Delvart V. Castaing D. Adam R. et al.Decision for retransplantation of the liver: an experience- and cost-based analysis.Ann Surg. 2002; 236: 713-721Crossref PubMed Scopus (179) Google Scholar]. The University of Pittsburgh [[17]Doyle H.R. Morelli F. McMichael J. Doria C. Aldrighetti L. Starzl T.E. et al.Hepatic retransplantation – an analysis of risk factors associated with outcome.Transplantation. 1996; 61: 1499-1505Crossref PubMed Scopus (138) Google Scholar] analyzed 418 (17.6%) patients who underwent RT out of 2376 LT performed from 1987 to 1993. The 1- and 5-year graft survival after RT was significantly lower than that of primary LT (50% and 35%, respectively). The leading causes of graft failure after RT were sepsis (44%) and ischemic injury-PNF (12%). The variables associated with graft failure after RT were donor and recipient age, female donor sex, the need for mechanical ventilation, renal failure, high levels of bilirubin and immunosuppression with cyclosporine. Some studies have suggested HCV-infection as a risk factor of mortality [25Neff G.W. O’Brien C.B. Nery J. Shire N.J. Nishida S. delaGarza J. et al.Factors that identify survival after liver retransplantation for allograft failure caused by recurrent hepatitis C infection.Liver Transpl. 2004; 10: 1497-1503Crossref PubMed Scopus (62) Google Scholar, 26Yao F.Y. Saab S. Bass N.M. Hirose R. Ly D. Terrault N. et al.Prediction of survival after liver retransplantation for late graft failure based on preoperative prognostic scores.Hepatology. 2004; 39: 230-238Crossref PubMed Scopus (91) Google Scholar, 27Rosen H.R. Madden J.P. Martin P. A model to predict survival following liver retransplantation.Hepatology. 1999; 29: 365-370Crossref PubMed Scopus (144) Google Scholar, 28Ghabril M. Dickson R. Wiesner R. Improving outcomes of liver retransplantation: an analysis of trends and the impact of hepatitis C infection.Am J Transplant. 2008; 8: 404-411Crossref PubMed Scopus (69) Google Scholar]. Rosen et al. [[27]Rosen H.R. Madden J.P. Martin P. A model to predict survival following liver retransplantation.Hepatology. 1999; 29: 365-370Crossref PubMed Scopus (144) Google Scholar] analyzed 1356 patients who underwent RT from the United Network for Organ Sharing (UNOS) from 1990 to 1996. Recipient age, bilirubin and creatinine levels, etiology of graft failure and UNOS status (intensive care, hospitalization, medical care or stable at home) were independent predictors of poor outcome after RT. Hepatitis C and donor age were associated with a poor prognosis on univariate analysis, but neither had enough power to be included in a predictive model. Similarly, Ghabril et al. [[28]Ghabril M. Dickson R. Wiesner R. Improving outcomes of liver retransplantation: an analysis of trends and the impact of hepatitis C infection.Am J Transplant. 2008; 8: 404-411Crossref PubMed Scopus (69) Google Scholar] have recently evaluated 1034 HCV-infected patients and 1249 non-HCV-infected patients who underwent RT between 1994 and 2005. Patient and graft survival were significantly lower for HCV-infected compared to non-HCV-infected patients who underwent RT at least 90 days after primary LT. However, based on multivariate analysis, the only independent predictors of mortality were recipient age, model for end-stage liver disease (MELD) >25, RT during the first year after LT, donor age >60 and, a warm ischemia time ⩾75 min. Other studies, have clearly identified HCV-infection as a risk factor of mortality not only after primary LT but also after RT [6Pelletier S.J. Schaubel D.E. Punch J.D. Wolfe R.A. Port F.K. Merion R.M. Hepatitis C is a risk factor for death after liver retransplantation.Liver Transpl. 2005; 11: 434-440Crossref PubMed Scopus (74) Google Scholar, 23Yoo H.Y. Maheshwari A. Thuluvath P.J. Retransplantation of liver: primary graft nonfunction and hepatitis C virus are associated with worse outcome.Liver Transpl. 2003; 9: 897-904Crossref PubMed Scopus (75) Google Scholar, 24Roayaie S. Schiano T.D. Thung S.N. Emre S.H. Fishbein T.M. Miller C.M. et al.Results of retransplantation for recurrent hepatitis C.Hepatology. 2003; 38: 1428-1436Crossref PubMed Scopus (77) Google Scholar]. One of the largest clinical UNOS series with more than 4000 patients who underwent RT from 1988 to 2001 [[23]Yoo H.Y. Maheshwari A. Thuluvath P.J. Retransplantation of liver: primary graft nonfunction and hepatitis C virus are associated with worse outcome.Liver Transpl. 2003; 9: 897-904Crossref PubMed Scopus (75) Google Scholar] showed seven risk factors for death after RT: PNF, HCV-infection, donor, and recipient age, creatinine -serum levels before RT, African-American race, and UNOS status. Patients with HCV recurrence were 20% and 30% more likely to lose their graft between 1 and 3 years compared with non-HCV-infected patients. Roayaie et al. [[24]Roayaie S. Schiano T.D. Thung S.N. Emre S.H. Fishbein T.M. Miller C.M. et al.Results of retransplantation for recurrent hepatitis C.Hepatology. 2003; 38: 1428-1436Crossref PubMed Scopus (77) Google Scholar] showed that HCV-infected patients undergoing RT had a significantly shorter median survival than those undergoing RT for other chronic reasons of graft loss. However, most deaths occurred during the first 6 months after RT and were due to sepsis by peritonitis or pneumonia. Similarly, Pelletier et al. [[6]Pelletier S.J. Schaubel D.E. Punch J.D. Wolfe R.A. Port F.K. Merion R.M. Hepatitis C is a risk factor for death after liver retransplantation.Liver Transpl. 2005; 11: 434-440Crossref PubMed Scopus (74) Google Scholar] analyzed 1718 RT patients (27% with HCV-infection) from 1997 to 2002 in the Scientific Registry of Transplant Recipients database. HCV-infected recipients had a 30% higher risk of mortality than those without HCV-infection (HR: 1.30; CI 95%: 1.10–1.54; p = 0.002). Most deaths occurred between 3 and 12 months after RT and variables associated with a worse outcome were donor and recipient age, serum-creatinine level, presence in the intensive care unit, and HCV-infection. The International Liver Transplantation Society Expert Panel [[29]Wiesner R.H. Sorrell M. Villamil F. Report of the first International Liver Transplantation Society expert panel consensus conference on liver transplantation and hepatitis C.Liver Transpl. 2003; 9: S1-S9Crossref PubMed Scopus (401) Google Scholar] established that bilirubin ⩾10 mg/dl, creatinine ⩾2.0 mg/dl (or creatinine clearance <40 ml/min), recipient age >55, donor age >40 and early HCV recurrence (cirrhosis <1 year after LT) were variables associated with a worse outcome after RT. The worse outcome after RT in cases of early severe hepatitis C recurrence has been shown in some studies [[28]Ghabril M. Dickson R. Wiesner R. Improving outcomes of liver retransplantation: an analysis of trends and the impact of hepatitis C infection.Am J Transplant. 2008; 8: 404-411Crossref PubMed Scopus (69) Google Scholar] but may reflect the poor liver function in individuals with cholestatic forms of hepatitis C at the time of RT [[10]Berenguer M. Prieto M. Palau A. Rayon J.M. Carrasco D. Juan F.S. et al.Severe recurrent hepatitis C after liver retransplantation for hepatitis C virus-related graft cirrhosis.Liver Transpl. 2003; 9: 228-235Crossref PubMed Scopus (101) Google Scholar]. Due to the lack of a clear consensus, different models based on logistic regression analysis of donor and recipient variables have been developed to help in the decision-making process of patients listed for RT. Most predictive models are derived from retransplanted individuals including urgent (PNF or HAT) and elective indications for RT [17Doyle H.R. Morelli F. McMichael J. Doria C. Aldrighetti L. Starzl T.E. et al.Hepatic retransplantation – an analysis of risk factors associated with outcome.Transplantation. 1996; 61: 1499-1505Crossref PubMed Scopus (138) Google Scholar, 20Markmann J.F. Gornbein J. Markowitz J.S. Levy M.F. Klintmalm G.B. Yersiz H. et al.A simple model to estimate survival after retransplantation of the liver.Transplantation. 1999; 67: 422-430Crossref PubMed Scopus (94) Google Scholar, 21Ghobrial R.M. Gornbein J. Steadman R. Danino N. Markmann J.F. Holt C. et al.Pretransplant model to predict posttransplant survival in liver transplant patients.Ann Surg. 2002; 236: 315-322Crossref PubMed Scopus (146) Google Scholar, 22Azoulay D. Linhares M.M. Huguet E. Delvart V. Castaing D. Adam R. et al.Decision for retransplantation of the liver: an experience- and cost-based analysis.Ann Surg. 2002; 236: 713-721Crossref PubMed Scopus (179) Google Scholar, 27Rosen H.R. Madden J.P. Martin P. A model to predict survival following liver retransplantation.Hepatology. 1999; 29: 365-370Crossref PubMed Scopus (144) Google Scholar, 30Linhares M.M. Azoulay D. Matos D. Castelo-Filho A. Trivino T. Goldenberg A. et al.Liver retransplantation: a model for determining long-term survival.Transplantation. 2006; 81: 1016-1021Crossref PubMed Scopus (43) Google Scholar] (Table 2). The first predictive models identified the need for mechanical ventilation [17Doyle H.R. Morelli F. McMichael J. Doria C. Aldrighetti L. Starzl T.E. et al.Hepatic retransplantation – an analysis of risk factors associated with outcome.Transplantation. 1996; 61: 1499-1505Crossref PubMed Scopus (138) Google Scholar, 20Markmann J.F. Gornbein J. Markowitz J.S. Levy M.F. Klintmalm G.B. Yersiz H. et al.A simple model to estimate survival after retransplantation of the liver.Transplantation. 1999; 67: 422-430Crossref PubMed Scopus (94) Google Scholar], UNOS status [[27]Rosen H.R. Madden J.P. Martin P. A model to predict survival following liver retransplantation.Hepatology. 1999; 29: 365-370Crossref PubMed Scopus (144) Google Scholar] and the urgency of RT [22Azoulay D. Linhares M.M. Huguet E. Delvart V. Castaing D. Adam R. et al.Decision for retransplantation of the liver: an experience- and cost-based analysis.Ann Surg. 2002; 236: 713-721Crossref PubMed Scopus (179) Google Scholar, 30Linhares M.M. Azoulay D. Matos D. Castelo-Filho A. Trivino T. Goldenberg A. et al.Liver retransplantation: a model for determining long-term survival.Transplantation. 2006; 81: 1016-1021Crossref PubMed Scopus (43) Google Scholar] as prognostic factors of mortality. Markmann et al. [[20]Ma" @default.
• W2079728952 created "2016-06-24" @default.
• W2079728952 creator A5033003648 @default.
• W2079728952 creator A5041306394 @default.
• W2079728952 creator A5042702249 @default.
• W2079728952 date "2010-11-01" @default.
• W2079728952 modified "2023-10-15" @default.
• W2079728952 title "Retransplantation in patients with hepatitis C recurrence after liver transplantation" @default.
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