Hepatitis C Genotype Influences Post-liver Transplant Outcomes. Issue 4 (April 2015)

• Record Type: Journal Article
• Authors: Campos-Varela, Isabel; Lai, Jennifer C.; Verna, Elizabeth C.; O'Leary, Jacqueline G.; Todd Stravitz, R.; Forman, Lisa M.; Trotter, James F.; Brown, Robert S.; Terrault, Norah A.
• Is Part Of: Transplantation. Volume 99:Issue 4(2015)
• Publication Date: 2015-04
• Subjects: Transplantation of organs, tissues, etc -- Periodicals; Transplantation immunology -- Periodicals; 617.95
• DOI: 10.1097/TP.0000000000000413
• Languages: English
• ISSNs: 0041-1337

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Background</title> <p>In nontransplant patients with chronic hepatitis C virus (HCV), HCV genotype has been linked with a differential response to antiviral therapy, risk of steatosis and fibrosis, as well as all-cause mortality, but the role of HCV genotypes in posttransplant disease progression is less clear.</p> </sec> <sec> <title>Methods</title> <p>Using the multicenter CRUSH-C cohort, genotype-specific rates of advanced fibrosis, HCV-specific graft loss and response of antiviral therapy were examined.</p> </sec> <sec> <title>Results</title> <p>Among 745 recipients (605 [81%] genotype 1, 53 [7%] genotype 2, and 87 [12%] genotype 3), followed for a median of 3.1 years (range, 2.0–8.0), the unadjusted cumulative rate of advanced fibrosis at 3 years was 31%, 19%, and 19% for genotypes 1, 2, and 3 (<italic>P</italic> = 0.008). After multivariable adjustment, genotype remained a significant predictor, with genotype 2 having a 66% lower risk (<italic>P</italic> = 0.02) and genotype 3 having a 41% lower risk (<italic>P</italic> = 0.07) of advanced fibrosis compared to genotype 1 patients. The cumulative 5-year rates of HCV-specific graft survival were 84%, 90%, and 94% for genotypes 1, 2, and 3 (<italic>P</italic> = 0.10). A total of 37% received antiviral therapy, with higher rates of sustained virologic response in patients with genotype 2 (hazard ratios, 5.10; <italic>P</italic> = 0.003) and genotype 3 (hazard ratios, 3.27; <italic>P</italic> = 0.006) compared to patients with genotype 1.</p> </sec> <sec> <title>Conclusion</title> <p>Risk of advanced fibrosis and response to therapy are strongly influenced by genotype. Liver transplantation recipients with HCV genotype 1 have the highest risk of advanced fibrosis and lowest sustained virologic response rate. These findings highlight the need for genotype-specific management strategies.</p> </sec> </abstract>