Introduction Chronic hepatitis C (CHC) is a leading cause of chronic liver disease in the UK. Orthotopic liver transplantation (OLT) is commonly used for end stage cirrhosis or hepatocellular cancer secondary to CHC. Unfortunately recurrence of CHC in the graft of transplant recipients is almost universal, often leading to accelerated liver damage. Our aim was to assess the outcome of patients attending a Regional Liver Unit in Northern Ireland who underwent OLT for liver disease due to CHC.
Methods A retrospective study was carried out of patients from Northern Ireland who had OLT between 1998 and 2010 for CHC associated chronic liver disease. Cases were identified by review of the regional OLT database and cross-referenced with the centre where OLT was carried out (KCH, London).
Results Sixteen patients (11 male) underwent 20 OLTs for CHC between April 1998 and December 2010 (<10% of all OLTs). Mean age was 54 years. 13 patients had single OLT and 3 required multiple transplants. The HCV genotypes were 1 (7), 3 (5) and 2 (4). Prior to OLT, 10 patients received antiviral therapy—all failed (five non-responders, two relapsed following treatment and three failed to tolerate treatment). Data were only available on 19 OLT episodes. Immunosuppressant maintenance therapy was as follows: tacrolimus (9), tacrolimus + mycophenolate (4), cyclosporine (1) and mycophenolate + prednisolone (1). Short-term complications included acute cellular rejection in 5 (26.3%) requiring pulsed methylprednisolone (4) or IL2 blockade (1). Two patients developed renal failure requiring short-term dialysis post transplantation. Long-term complications included biliary anastomotic stricture in 6 (31%) patients and vascular complications in 3 (2 hepatic artery thrombus, 1 hepatic vein stenting). One patient acquired hepatitis B from the transplanted liver. Reasons for re-transplantation were hepatic artery thrombosis (2), recurrent cirrhosis with portal hypertension (1) and primary non-function of the graft (1). Seven (35%) transplants had cirrhosis confirmed on biopsy (5) or clinically (ascites (1) or oesophageal varices (1)) at a mean time of 25.6 months post transplant (range 12–48 months). Five-year mortality in the cohort was 25%.
Conclusion Hepatitis C accounted for <10% of OLT episodes in Northern Ireland during the study period. This demand may increase in the future as the chronic complications of previously undiagnosed hepatitis C are seen. One third of this small cohort developed cirrhosis within a few years of OLT.
Competing interests None declared.
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