Predictors of hepatitis C virus recurrence after living donor liver transplantation: Mansoura experience

Background and study aims Hepatitis C virus (HCV)-related cirrhosis is the leading cause of liver transplantation (LT). All patients who undergo LT with detectable serum HCV-RNA experience graft reinfection, which is the most frequent cause of graft loss and death in these patients. We estimated the rate of HCV recurrence and evaluated the current therapeutic regimens. Patients and methods The records of consecutive 325 living donor LT (LDLT) surgeries performed between May 2004 and August 2014 were retrospectively analysed; 207 of them were followed-up throughout the study. Clinical, laboratory, radiological and histopathological examinations were performed thoroughly. Patients received treatment in the form of either pegylated interferon (PEG-IFN) or sofosbuvir, both in combination with ribavirin. Results In total, 90.3% of recipients who were transplanted because of HCV-related end-stage liver disease experienced recurrence due to the virus. The donor age was older in the HCV recurrent group versus the non-recurrence group (28.7 ± 7.1 versus 22.6 ± 2.6 years: p ≤ 0.001), warm ischaemia time was prolonged (46.1 ± 18.1 versus 28.6 ± 4.1 min: p ≤ 0.001), median cold ischaemia time was 40.0 (10–175) versus 22.5 (15–38) min (p ≤ 0.001) and basal PCR was 414000 (546-116000000) versus 10766 (1230-40000) (p ≤ 0.001). Sustained virological response was achieved in 95.4% of patients treated with a combination of a fixed daily dose of 400 mg sofosbuvir with ribavirin and in 65.1% of those who were treated with PEG-IFN with ribavirin. Conclusions Older donor age and prolonged warm ischaemia time are independent predictors of HCV recurrence after LDLT, and early treatment with the direct-acting sofosbuvir is helpful in resolving the problem of post-LT HCV recurrence.