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Recurrent Hepatitis C Virus (Genotype 4) Infection after Living Donor Liver Transplantation: Risk Factors and Outcome

Emad Hamdy Salem, Mohammed Taha, Amr Aziz, Ayman Alsebaey, Khaled Abou El-Ella and Tarek Ibrahim

Objectives: The recurrence of HCV post liver transplantation endangers patient and graft survival. The aim of this study is to analyze the risk factors for HCV recurrence, the effect of the recurrence and its management on the outcome of liver transplantation.

Materials and methods: After exclusion of the 6 months mortality, dual HCV and HCC patients, about fifty five HCV related LDLT patients were enrolled in the study and were followed up from 6 to 60 months. Demographic, preoperative, intraoperative and postoperative data were studies. HCV recurrence was defined by elevated transaminases, positive serum HCV RNA and liver biopsy findings. Univariate and multivariate analysis were done on all data to detect the favoring factors of HCV recurrence.

Results: HCV recurrence occurred in 21/55 of the patients and one of them developed cirrhosis on follow up. By univariate analysis; CMV infection, mean operative time (12.490 ± 1.8952), acute cellular rejection and pulse steroids treatment were predictors of HCV recurrence (P<0.05). Multivariate analysis revealed only acute cellular rejection to be a predictor. The overall 1, 3 and 5 years’ survival of all patients was 94.5%, 90.9% and 90.9% respectively, while the overall 1, 3 and 5 years’ survival of patients with and without recurrence was 95.2%, 90.5% and 90.5% and 94.1%, 91.2%and 91.2% respectively.

Conclusion: The occurrence of acute rejection was independent predictor of HCV recurrence post LDLT, so its prevention is required to decrease this recurrence. Similarly, prevention of CMV infection and decreasing operative time is important to decrease post-transplant HCV recurrence.