Outcome of liver transplantation for recipients with hepatitis B and hepatitis C virus coinfection: analysis of the UNOS data.

BACKGROUND

Coinfection by Hepatitis B virus (HBV) and hepatitis C virus (HCV) has been reported to increase risk of graft failure for liver transplant recipients. But other studies have controverted that finding. The aim of this study was to determine whether-after adjustments for other important predictors-HBV/HCV coinfection was associated with worse liver graft survival than HBV or HCV mono-infection.

METHODS

A retrospective cohort study examined Organ Procurement and Transplantation Network/United Network Organ Sharing data for 48,654 deceased-donor primary liver-only transplants that were performed on adults between January 1, 1995, and August 31, 2009, and that included recipient and donor HBV/HCV status. Recipients were classified into four groups: the HBV/HCV coinfected [B+/C+]; HBV mono-infected [B+/C-]; HCV mono-infected [B-/C+]; and hepatitis uninfected [B-/C-]. Kaplan-Meier methods were used to calculate liver graft survival rates, Cox proportional hazard models were used to estimate the effect of hepatitis virus infection, and adjusted for potential confounders.

RESULTS

Graft survival rates were highest with B+/C-: 85.3% 1-year survival and 63.0% 10-year survival. Graft survival with B+/C+ was superior to survival with B-/C+: 83.5% 1-year survival and 53.6% 10-year survival vs. B-/C+: 82.9% 1-year survival and 46.1% 10-year survival. Survival with B-/C-: 83.6% 1-year survival and 56.6% 10-year survival was superior to survival with B+/C+ (shown above). After adjustment for confounders, and with the coinfected as reference, B-/C+ recipients had a higher risk of graft loss (hazard ratio, 1.35; 95% CI, 1.10-1.66); the other two groups had a lower risk.

CONCLUSIONS

Our results suggested-despite reports to the contrary-statistically better graft outcomes with HBV/HCV coinfection than with HCV mono-infection.