Study of Overall Survival and Factors Affecting Outcomes in Chronic Hepatitis C Patients Undergoing Liver Transplantation: A Single-centered Cohort Study
Chitchai Rattananukrom, MD1, Kongpob Yongrattanakit, MD1, Tanita Suttichaimongkol, MD1, Witsarut Manasirisuk, MD1, Kookwan Sawadpanich, MD1, Apichart Sangchan, MD2, Kawin Tangworapongchai, MD2, Pisaln Mairiang, MD2, Wattana Sukeepaisarnjareon, MD1
Affiliation : 1Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand, 2Center of Excellence, Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine, Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand
Background: Chronic hepatitis C virus (HCV) infection is a significant global health concern, including in Thailand. It can lead to progressive liver diseases such as cirrhosis and hepatocellular carcinoma (HCC). Liver transplantation (LT) is recognized as the curative treatment for early-stage HCC and decompensated cirrhosis. However, LT recipients with chronic HCV infection tend to have lower survival rates compared to those with other indications, with graft failure due to HCV recurrence and HCC development being the primary causes of mortality. While studies in Western countries have explored various factors influencing outcomes, including HCC, similar research is lacking in Asia and particularly in Thailand.
Objective: The present study aims to fill this gap by examining overall survival and factors affecting outcomes in chronic hepatitis C patients undergoing liver transplantation at Srinagarind Hospital.
Materials and Methods: A retrospective cohort study was conducted. The 16-year period, medical records of adult liver transplant recipients with HCV infection, transplanted between January 2008 and May 2023, were systematically reviewed. Recipients with only anti-HCV positive and lacking confirmation of HCV viral load before transplantation were excluded. Patient medical records were meticulously abstracted to gather information, including the overall survival of LT recipients with chronic HCV infection. Survival curves were generated using the Kaplan-Meier method and compared using the log-rank test. Univariate Cox proportional hazard models were employed to calculate hazard ratios for variables associated with death. The primary outcome was the overall survival of LT recipients with chronic HCV infection and secondary outcomes were factors affecting overall survival, the rate of HCV recurrence, cirrhosis recurrence, and HCC recurrence.
Results: The medical records of 81 adult liver transplantation recipients with chronic hepatitis C transplanted at Srinagarind Hospital. HCV recurrence was observed in nearly all cases (98.6%) where HCV viral load was detectable prior to liver transplantation. Subsequently, approximately 72% of patients underwent HCV treatment after LT, with a 100% success rate in achieving sustained virological response (SVR) among those treated. At the last follow-up, 76.8% of patients were SVR. Cirrhosis recurrence occurred in 4.9% of cases, while HCC recurrence was noted in 7.4% of cases. The 5 year overall survival rate for liver transplant recipients was 75.3%. For factors affecting patient outcomes, HCC recurrence (HR=26.55; 95% CI=5.14 to 137.21; p<0.001) and cirrhosis recurrence (HR=9.05; 95% CI=1.79 to 45.87; p=0.008) were also found to be correlated with an increased risk of mortality. On the other hand, both HCV treatment after LT (HR=0.09; 95% CI=0.03 to 0.3; p<0.001) and achieving SVR status at the final follow-up visit (HR=0.13; 95% CI=0.05 to 0.35; p<0.001) were significantly associated with a reduced risk of death.
Conclusion: Over the 16-year period, the 5-year overall survival rate for liver transplant recipients with chronic HCV infection was 75.3%. The recurrence of HCC and cirrhosis were the significant risk factors for reducing overall survival. Conversely, LT patients who underwent HCV treatment and achieved SVR status at the final follow-up visit demonstrated a good factor to improve overall survival.
Keywords : Chronic hepatitis C (HCV); Liver transplantation; Overall survival; HCV recurrence after liver transplantation; Hepatocellular carcinoma (HCC) recurrence after liver transplantation; Cirrhosis recurrence after liver transplantation; HCV treatment; Sustained virological response (SVR); Thai
