IS RETRANSPLANTATION FOR HCV A BAD IDEA RESULTS OF A U'S' MULTICENTER RETRANSPLANT STUDY

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IS RETRANSPLANTATION FOR HCV A BAD IDEA? RESULTS
OF A U.S. MULTICENTER RETRANSPLANT STUDY

• T. McCashland MD, E. Lyden MS, K .Watt,
• L Adams MD, M. Charlton MD, B McGuire MD,
• A Smith MD, S Biggins MD, M. Alonzo RN,
• G. Neff MD, J Burton MD, H. Vargus MD,
• J. Donovan MD, J. Trotter MD, T. Faust MD

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INVESTIGATORS

• Brendon McGuire MD
• Scott Biggins MD
• James Trotter MD
• Leon Adams MD,
• Michael Charlton MD
• Mike Alonzo RN
• Guy Neff, MD
• James Burton MD
• Thomas Faust MD
• John Donovan MD
• Alastair Smith MD
• Hugo Vargus MD

• U. of Alabama
• UCSF
• U. of Colorado
• Mayo Clinic Rochester
• U. of Cincinnati
• U. Oregon
• U. of Pennsylvania
• USC
• Duke
• Mayo Clinic Scottsdale

Supported by educational grant Roche
Pharmaceuticals
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AIMS

• Compare patient survival after retransplantation
  in patients with graft failure due to recurrent
  hepatitis C with other indications in a
  multicenter U.S. study group.
• Identify how many patients were considered for
  relisting for retransplantation with HCV. How
  many died prior to retransplantation and reasons
  for exclusion for retransplantation.
• Evaluate the length of hospitalizations of
  retransplantation of the different groups.

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METHODS

• Retrospective review from 10 U.S. centers with
  pathological confirmation of reason for primary
  graft loss (HCV vs Other).
• All patients retransplanted gt 90 days after first
  transplant from 1996-2004.
• All patients with recurrent hepatitis C
  considered for reevaluation same time period also
  studied.
• Kaplan-Meier survival methods, Fisher exact test
  and Wilcoxon rank test were used for analysis.

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DEMOGRAPHICS
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INDICATIONS FOR RETRANSPLANTATION IN NON-HCV
PATIENTS
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LIST TIMES AND TRANSPLANT TIMES
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MELD SCORES
Plt0.001
Plt0.001
P0.006
P0.01
P0.02
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HOSPITAL STAY
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PRIMARY CAUSE OF DEATH
12
years
13
years
14
years
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RECURRENT HCV NOT RETRANSPLANTED
Evaluated for retransplant 40/129
(31) Listed for retransplant
25/129 (19) Listed but died prior to
retransplant 16/25 (64)
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CONCLUSIONS

• Patients retransplanted for recurrent HCV
  compared to other indications had similar
• 1 and 3 year survival.
• Patient survival for retransplantation remains
  poorer than initial transplantation.
• MELD scores were not predictive of survival.
  However, a MELD score of gt30 in the
• non HCV group survival was lt 50

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CONCLUSIONS

• Length of time for hospitalization and ICU were
  similar between the two retransplant groups.
• Many patients with recurrent HCV are not
  considered for retransplantation and die from
  recurrent disease.