BOSTON -- November 4, 2009 -- Treatment with pegylated
interferon and ribavirin (PEG/RBV) therapy during
compensated cirrhosis is the most cost-effective strategy
for antiviral administration in the setting of advanced
hepatitis C virus (HCV)-related liver disease, researchers
noted here at the Liver Meeting 2009, the 60th Annual
Meeting of the American Association for the Study of Liver
Diseases (AASLD).
This strategy yields the greatest survival benefit with the
lowest associated cost; it reverses cirrhosis, and prevents
decompensation, transplantation, hepatocellular carcinoma (HCC),
and death. Sammy Saab, MD, MPH, David Geffen School of
Medicine, University of California, Los Angeles, Los
Angeles, California, and colleagues reported evidence from
their study for treating HCV in patients with compensated
cirrhosis before it progresses to more advanced liver
disease. The poster presentation was held here on October
31.
Antiviral therapy for the treatment of HCV infection is used
both before and after liver transplantation. The objective
of this study was to determine the ideal timing for PEG/RBV
therapy in patients with advanced liver disease infected
with genotype 1 HCV.
The 4 treatment groups were as follows: (1) no antiviral
treatment, (2) antiviral therapy in patients with
compensated cirrhosis, (3) antiviral therapy in patients
with decompensated cirrhosis, and (4) antiviral therapy in
patients with recurrent HCV post transplant. A Markov model
was constructed comparing treatment strategies. Outcomes of
interest were total cost per patient, number of
quality-adjusted life-years (QALYs) saved, number of deaths,
number of HCCs, and number of transplants required. Each of
the 4 treatment arms comprised 1,000 patients.
The total cost per patient for treatment during compensated
cirrhosis was $331,425; the total cost per patient for each
of the other 3 treatment groups was approximately $152,000
more. The life expectancy for treatment during compensated
cirrhosis was almost 10 QALY; for the other 3 groups it was
about 7 QALY.
In the 10-year outcome data, a total of approximately 250
patients died in the compensated cirrhosis treatment group;
approximately 500 patients died in each of the other 3
groups. A total of approximately 175 patients had a
transplant in the compensated cirrhosis treatment group;
approximately 200 patients had a transplant in each of the
other 3 groups. About 50 patients had regression of
cirrhosis in the compensated-cirrhosis treatment group.
Treatment of patients with compensated cirrhosis was the
most cost-effective strategy; it resulted in improved
survival and decreased cost when compared with the other 3
strategies. Treatment after development of decompensated
cirrhosis or post transplant was also cost-effective, but
these patients derived less survival benefit at greater cost
(when compared with patients treated during compensated
cirrhosis). Patients who were allowed to develop more
advanced disease had a considerably worse prognosis. All 3
treatment strategies appeared more cost-effective than "no
treatment," which suggests that these patients may benefit
from antiviral treatment.
"Given these results, we strongly recommend expeditious
administration of antiviral therapy to patients with
compensated cirrhosis before their disease advances," the
authors stated.
These treatment strategies must be studied further, however,
before they can be universally recommended, they advised.
[Presentation title: Timing of Hepatitis C Antiviral Therapy
Pre and Post Liver Transplantation: A Decision Analysis
Model. Abstract 503]
Patients who have
undergone a liver transplant may have a significantly increased
risk for developing cardiovascular risk factors. Researchers
from New York Medical College assessed the incidence of new
coronary risk factors and coronary artery disease in 200
patients (mean age, 58 years) after liver transplantation. All
patients received prednisone for the first 3 months after
transplantation. For the 2 years after transplantation, 36
patients were treated with cyclosporine plus mycophenolate, 154
with tacrolimus plus mycophenolate, and 10 with prednisone plus
tacrolimus or cyclosporine plus mycophenolate. During 2 years
after liver transplantation, the incidence of
hypertension increased 36 percent,
diabetes increased 17 percent, hypercholesterolemia
increased 21 percent, and coronary artery disease increased 6
percent. Researchers attributed the increase in cardiovascular
risk factors to the drugs used to prevent transplant rejection.
ACLS Training May Be Inadequate for Treatment of
Cardiopulmonary Arrests (#8685)
Advanced Cardiac Life Support (ACLS) certification may not
adequately prepare health-care professionals for performing
these certified skills in a clinical setting. Using patient
simulations, a research team from Long Island Jewish Medical
Center in New York tested 35 incoming medical house staff on
chest compressions (CC) and initial airway management (IAM). Of
the 35 house officers, 25 had received ACLS training (group 1)
and 10 had not received this training (group 2) prior to
testing. For CC, group 1 scored 3.16±1.95 and group 2 scored
4.40±1.65 out of the maximum possible score of 11. For IAM,
group 1 scored 2.12±1.17 and group 2 scored 1.60±1 out of the
maximum possible score of 12. Researchers conclude that ACLS
certification had no impact on performance of the key tasks of
CC and IAM during a simulated in-hospital cardiopulmonary
arrest.
Asian Indians Experience Heart Attacks Earlier Than
Caucasians (#8071)
People of Indian origin experience
heart attacks at a much earlier age than Caucasians.
Researchers from Maimonides Medical Center in New York analyzed
a total of 752 patients (55 years or younger) who had a
myocardial infarction (MI) over a 14-year period. The two most
predominant groups were people of Indian origin (group I, n=132)
and Caucasian (group C, n=447). Results showed that group I
presented with an MI at a significantly earlier age compared
with group C (45±5.5 years vs. 48±5.8 years). Researchers
speculate that the ethnic difference seen in MI presentation
could be due to inadequate preventive care or unexplored genetic
factors.
Source: Jennifer Stawarz
American College of Chest Physicians
AASLD: Survival Lower in HCV-Infected
Women after Liver Transplant
BOSTON -- Women undergoing liver transplant as a result of
hepatitis C virus (HCV) infection show poorer long-term survival
rates and more frequent failure of the donor liver, compared
with male recipients, a researcher said here.
Female gender was associated with a hazard ratio for five-year
mortality of 1.46 (95% CI 1.04 to 2.03) in multivariate analysis
of 195 female and 655 male liver recipients, reported Jennifer
Lai, MD, of the University of California San Francisco.
Women were also at almost 40% higher risk for overall graft loss
(HR 1.39, 95% CI 1.39 to 1.89), Lai said here at the annual
meeting of the American Association for the Study of Liver
Disease.
Action Points
·Explain to interested
patients that the study suggested that HCV-infected women may
have worse outcomes than men after liver transplantation, but
the reasons were unknown.
·Explain that there are few
alternatives to transplantation for patients with advanced liver
disease related to HCV infection.
·Note that this study was
published as an abstract and presented at a conference. These
data and conclusions should be considered preliminary until
published in a peer-reviewed journal.
"Further studies are needed to evaluate modifiable donor factors
and post-transplant therapies that influence [women's]
outcomes," she told attendees at a plenary presentation.
She said previous studies were equivocal on whether gender
affects survival and graft loss rates in HCV-infected liver
transplant recipients.
Moreover, the earlier research included patients whose
transplants occurred before the current system for allocating
donor livers, based on Model for End-Stage Liver Disease (MELD)
scores, was instituted earlier in the decade.
The study conducted by Lai and her colleagues included all adult
liver transplant recipients with HCV-related liver disease at a
network of four major centers from March 2002 to December 2007.
A
co-diagnosis of hepatocellular carcinoma was not an exclusion,
but patients with HIV or who were negative for HCV RNA after
transplant were excluded, as were those whose grafts failed
within a month of transplant.
Overall, with median follow-up of 3.1 years, 22% of transplant
recipients had died and 25% had sustained graft loss.
Graft loss with recurrent HCV infection occurred in 10% of
patients. Advanced recurrent disease was seen in 26%.
Lai said that women were at substantially increased risk for
these latter outcomes -- a 44% increased chance of advanced
recurrent HCV and 84% higher rates of graft loss associated with
recurrent infection.
In addition to female gender, factors significantly associated
with outcomes included:
·African-American race: HR
for mortality 1.66 (95% CI 1.09 to 2.55); HR for graft loss 1.51
(95% CI 1.00 to 2.26)
·Post-transplant antiviral
treatment: HR for mortality 0.57 (95% CI 0.40 to 0.80); HR for
graft loss 0.70 (95% CI 0.51 to 0.95)
·Donor age, per year: HR for
mortality 1.03 (95% CI 1.02 to 1.04); HR for graft loss 1.02
(95% CI 1.01 to 1.03)
Lai emphasized that these factors were adjusted for in the
hazard ratios calculated for female gender.
She suggested several potential explanations for the higher
risks that women appeared to run:
·Differential effects of
aging in women compared with men
·Gender mismatch between
donors and recipients -- these were more common with female
versus male recipients in the study
·Renal impairment prior to
transplant, also more likely to occur with women than men in the
sample
Gregory Everson, MD, a hepatologist at the University of
Colorado in Denver, who was not involved in the study, said he
was not entirely surprised by the findings.
He said one of the first studies to examine the role of gender
in liver transplant outcomes had also found a disadvantage for
women. "This kind of confirms the finding," Everson said.
He added that, at this point, there wasn't a clear clinical
implication. Everson agreed with Lai that more research is
needed to identify the factors underlying the gender differences
and how they might be alleviated either prior to or after
transplantation.
The study was supported by the National Institutes of Health.
Lai had no potential conflicts of interest. Other co-authors
reported relationships with Salix, Gilead, GlaxoSmithKline,
Novartis, Schering, Vertex, Roche, Siemens, Schering-Plough,
SciClone, and Human Genome Sciences.
Everson reported relationships with Schering-Plough and Ortho
Biotech.
Primary source:
Hepatology
Lai J, et al "Hepatitis C virus (HCV) infected females are at
higher risk of graft loss after liver transplantation (LT): A
multicenter cohort study" Hepatology 2009; 50: S304A-305A.
Noninvasive Breath Test Predicts Survival in Patients with Viral
Hepatitis
Presented Monday,
November 2, 2009 at 8:00 a.m. Eastern Time in Boston, MA
ALEXANDRIA, Va. and BOSTON, Nov. 2 /PRNewswire/
-- A methacetin breath test (MBT) that can be performed
quickly and noninvasively has been proven to accurately predict
survival in patients with viral hepatitis and may be used as an
adjunctive tool to MELD. "The breath test has to be validated on
a large cohort of patients," said Gadi Lalazar, MD, principal
investigator on this study "but if it is validated, this non
invasive liver function test will be able to identify liver
impairment at all stages of liver disease - both acute and
chronic."
MELD (Model for End-Stage Liver Disease) is a
scoring system adopted by the United Network for Organ Sharing
to assess liver disease severity and determining 3-month
mortality. Viral hepatitis progresses at an unpredictable rate
and the addition of another way of assessing disease progression
can serve as an important adjunct to MELD.
Researchers studied 395 patients with viral
hepatitis. The MBT accurately predicted survival. Of those
patients, 11 had died in the two years in which data were
collected. MBT identified 9 of these 11 patients as being high
risk. Whereas 6 of those 11 deaths occurred in patients with a
MELD score less than 15 - patients who were considered at a low
risk by the MELD scoring system. In addition, MBT accurately
predicted survival in patients with a higher MELD score and,
therefore, at increased risk as defined by MELD.
They concluded that MBT may increase physicians'
ability to identify at-risk patients and allow those patients to
be listed for liver transplantation earlier than using MELD
alone to determine mortality. "We are now conducting large scale
clinical trials to assess the role of the methacetin breath test
for follow up and therapeutic decision making in patients with
chronic hepatitis B and in non-alcoholic fatty liver disease,"
said Dr. Lalazar.
Abstract title:
The noninvasive 13C methacetin breath test
accurately predicts long-term survival in patients with chronic
viral hepatitis and may serve as an adjunctive tool to MELD:
Results of a 395-patient clinical trial.
Viral Load Predicts Outcome of Liver
Transplant Recipients with Hepatitis C: Presented at AASLD
BOSTON -- November 2, 2009 -- Viral load is an important factor and
can predict the outcome of patients with hepatitis C virus (HCV)
after liver transplantation, for both the development of the
different types of recurrent HCV and patient survival, researchers
stated here at the Liver Meeting 2009, the 60th Annual Meeting of
the American Association for the Study of Liver Diseases (AASLD).
Ivo
Graziadei, Department of Internal Medicine II, Medical University of
Innsbruck, Innsbruck, Austria, and colleagues reported the findings
from their study in a poster session here on October 31.
After
liver transplant, recurrent HCV infection is ubiquitous and leads to
graft loss and re-transplantation for 10% to 20% of liver transplant
recipients. Donor, recipient, and viral parameters are the risk
factors associated with HCV recurrence.
As
there has been conflicting data reported about the viral load and
the severity of recurrent HCV disease, the aim of this study was to
analyse the impact of the viral load upon the severity of the
recurrent HCV infection.
The
study included data from 129 patients who received liver transplants
due to HCV cirrhosis between 1980 and 2006 at the Medical University
of Innsbruck and, who survived more than 6 months, and had
histologically proven recurrent HCV infection.
Viral
load was measured at week 2, and at
months 3, 6, and 12 post-transplant (using the bDNA HCV RNA 3.0
assay by Bayer Diagnostics). There was a mean overall follow-up of
6.1 +- 3.6 years. Annual liver biopsies began in 2000; before that,
biopsies were performed only in patients with elevated serum
transaminases.
The
majority of patients (81.4%) had no, or only mild to moderate HCV
recurrence; 18.6% developed either a cholestatic type of recurrence
(8.6%) or a rapid progression to advanced fibrosis/cirrhosis (9.1%).
Early
viraemia (HCV RNA levels >6.0 log10 IU/mL) at week 2 were highly
predictive for the cholestatic type of recurrence and poor patient
survival. High viral loads (>6.5 log10 IU/mL) at month 3 were
associated with recurrent cirrhosis of the liver allograft.
Presentation Title: Viral Load Predicts Outcome of Hepatitis C
Patients After Liver Transplantation. Abstract 516
Post-transplant
Prophylactic Antiviral Treatment Does Not Prevent Recurrent
Hepatitis C: Presented at AASLD
Nov 1 09
Cheryl
Lathrop
BOSTON -- November 1, 2009
-- Post-transplant prophylactic antiviral treatment with pegylated
interferon (PEG-IFN) alfa-2a plus ribavirin to prevent recurrent
hepatitis C is associated with a low rate of sustained virologic
response (SVR), adverse events (anaemia, neutropenia), and a high
rate of discontinuation.
Natalie Bzowej, MD, California Pacific Medical Center, San
Francisco, California, and colleagues presented the findings from
the PEGASYS and COPEGUS Administered After Liver Transplantation for
Hepatitis C (PHOENIX) study here on October 31 at the Liver Meeting
2009, the 60th Annual Meeting of the American Association for the
Study of Liver Diseases (AASLD).
Recurrent allograft hepatitis due to hepatitis C virus (HCV) can be
aggressive and can result in graft loss. Prevention of allograft
hepatitis C by post-transplant prophylaxis with antiviral treatment
is desirable and PEG-IFN alfa-2a plus ribavirin is one strategy.
However, data from large randomised controlled trials concerning the
optimal timing of PEG-IFN alfa-2a/ribavirin was lacking.
The prospective, multicentre, open-label, randomised study compared
prophylactic treatment with a low accelerating dose regimen of PEG-IFN
alfa-2a/ribavirin versus initiating the same antiviral regimen only
upon observation of histologically confirmed recurrent HCV
infection. PHOENIX measured the efficacy, tolerability, and safety
of prophylactic treatment at 10 to 26 weeks post-transplant.
Patients were aged >=18 years and had undergone orthotopic liver
transplantation (OLT) due to liver disease from HCV infection.
Patients were clinically stable and expected to be able to tolerate
PEG-IFN alfa-2a/ribavirin therapy.
At 10 to 26 weeks post transplant, patients were randomised to
either the prophylaxis arm (n = 55) which consisted of PEG-IFN
alfa-2a 135 to 180 mcg/week plus ribavirin 400 to 1,200 mg/day for
48 weeks or to the observation arm (n = 60) in which patients were
treated for 48 weeks after histologically confirmed HCV recurrence.
The study lasted 120 weeks and all treated patients had 24 to 72
weeks of treatment-free follow-up.
The primary endpoint was the percentage of patients with
histologically confirmed HCV recurrence at 120 weeks
postrandomisation. Secondary endpoints included Histological
Activity Index (HAI) grades and Fibrosis Score (FS) at weeks 48 and
120, virologic response rates defined by undetectable HCV RNA, and
biopsy-proven acute allograft rejection, graft loss, or death (a
combined endpoint).
There was no difference between the study arms in the primary
endpoint of histologically confirmed HCV recurrence at 120 weeks.
The distribution of HAI grades and FS scores at baseline and week
120 post randomisation was generally similar in both arms.
Virologic response rates were generally similar between the 2 arms.
Three patients in each arm had biopsy-proven acute allograft
rejection by week 120.
The frequency of adverse events was generally similar between the 2
arms.
"Given the significant toxicity associated with PEG-IFN alfa-2a plus
ribavirin therapy in post-OLT patients, without a clear benefit in
terms of HCV recurrence or SVR, this study does not provide
sufficient evidence to support routine use of prophylactic therapy."
[Presentation Title: A Randomized Controlled Trial of the
Efficacy, Tolerability, and Safety of Prophylactic Treatment With
Peginterferon alfa-2a Plus Ribavirin After Orthotopic Liver
Transplantation (OLT) for Hepatitis C: The PHOENIX Study. Abstract
506]
Extending
Treatment After Liver Transplant May Benefit Patients With Hepatitis
C Recurrence
Extending hepatitis
C treatment for liver transplant patients beyond
current practice results in high rates of clearance
of the hepatitis C virus from the blood, as well as
a low rate of relapse, according to a Henry Ford
Hospital study.
"We found that patients who
achieved a sustained virological response were more
likely to have had extended treatment," says
Kimberly Brown, M.D., Division head of
Gastroenterology at Henry Ford Hospital and senior
author of the study.
"In addition, prolonging treatment
for 52 weeks after patients were virus negative,
resulted in a relapse rate of only 8 percent." This
is in contrast to typical relapse rates of 30-35
percent in non transplant patients treated with
standard therapy.
Study results will be presented
during an oral presentation Oct. 31 at the American
Association for the Study of Liver Diseases' Annual
Meeting in Boston.
The study looked at 241
consecutive liver transplant patients from
1999-2006. Patients were offered treatment if they
tested positive hepatitis C, had recurrent hepatitis
C with at least Stage I fibrosis on biopsy, and
stable immunosuppression for a minimum of three
months. Patients received either non-pegylated
interferon tiw or pegylated interferon weekly in
combination with ribavirin.
Of the study patients with
hepatitis C, 66 were eligible for treatment, and 22
achieved sustained virological response. Only two
patients (8 percent) relapsed.
After week 24 of treatment, 35
percent of patients who achieved a sustained
virologic response became virus negative.
"These results call into question
previous studies which suggested 'stop rules' at
weeks 12 and 24 when there is no response to
inferferon and ribravirin," says Dr. Brown. "Our
results suggest that even if patients are positive
at week 24, there is still a 35 percent chance that
they can achieve sustained viral clearance. We think
this may be beneficial to extend treatment beyond
the standard 48 weeks total."
According to the U.S. Department
of Health & Human Services, more than 16,000 liver
transplants were performed last year and there are
currently almost 18,000 Americans on the liver
transplant list.
African Americans Fare Worse After Undergoing
Liver Transplantation Due to
Hepatitis C
Presented Monday, November 2, 2009 at 4:45 pm Eastern Time in
Boston, MA
African Americans Fare Worse After
Undergoing Liver Transplantation Due to Hepatitis C
ALEXANDRIA, Va. and BOSTON, Oct. 31 /PRNewswire/ --
Previous studies have
shown that hepatitis C virus (HCV) progresses slower prior to liver
transplantation in African Americans than in whites. However,
researchers
demonstrate in this study, which will be presented at the annual
meeting of
the American Association for the Study of Liver Diseases, that the
opposite is
true after transplantation, in that recurrent HCV in the
transplanted liver
progresses faster in African Americans than in whites. "I believe
this study
highlights the need, in all patients, for early close clinical
monitoring,
including the use of early protocol biopsies, to identify these
patients that
have early disease progression post-transplantation," said Jennifer
Layden,
MD, PhD, principal investigator on this study.
This retrospective multisite cohort study of 771 patients from 5
sites
evaluated patients who had a liver transplantation between 1999 and
2008. All
patients were transplanted due to liver failure caused by HCV. Data
were
analyzed at 6 months, 1 year, and 2 years after transplantation.
The researchers found, based on an analysis of liver biopsies
performed after
transplantation, that African Americans had more severe fibrosis
progression
and histologic inflammation compared to whites following liver
transplantation
for HCV. While Hispanics demonstrated similar disease
progression after liver
transplantation as whites, African Americans more often experienced
graft
failure and required repeat liver transplantation compared to
whites. In
addition, the hazard ratio for patient death for African Americans
was 1.3,
indicating a 30% higher mortality for African Americans compared to
whites.
The researchers concluded that African Americans who undergo liver
transplantation caused by HCV had more severe fibrosis progression
and
histologic inflammation compared to whites undergoing the same
procedure.
"While this study illustrates that HCV histologic progression occurs
early and
is more aggressive in African Americans, it does not allow a careful
analysis
of factors that may be contributing to these differences," concluded
Dr.
Layden, "we are conducting a multi-site prospective study to not
only confirm
these retrospective findings, but also examine both donor and host
factors,
including psychosocial, virologic, genetic and immunologic that may
contribute
to this important health disparity."
Abstract title:
Hepatitis C virus (HCV) progresses more rapidly after orthotopic
liver
transplantation (OLT) in African-Americans (AA) compared to whites
(W)
About the AASLD
AASLD is the leading medical society focused solely on advancing the
science
and practice of hepatology and represents more than 3,300
practitioners,
researchers, and allied health professionals worldwide. Founded by
physicians
in 1950, AASLD has upheld the standards of the profession and
fostered
research that generates treatment options for the millions of
patients with
liver diseases.
This year's Liver Meeting, held in Boston, Massachusetts, October 30
-
November 3, will bring together more than 7,000 researchers from 55
countries.
A pressroom will be available from October 31 at the annual meeting.
For
copies of abstracts and press releases, or to arrange for
pre-conference
research interviews contact Gregory Bologna at 703-299-9766. To
pre-register,
call Ann Tracy at 703-299-9766.
Press releases, additional information for the media, and all
abstracts are
available online at www.aasld.org.
Media Contact: Gregory Bologna
703/299-9766
gbologna@aasld.org
Press Room: October 31 - November 3, 2009
Hynes Convention Center, Room 209
Telephone: (617) 954-2827
Researcher: Jennifer Layden, MD, PhD
Email: jlayde1@uic.edu
Phone: (312) 804-9087
This release was issued through The Xpress Press News Service,
merging e-mail
and satellite distribution technologies to reach business analysts
and media
outlets worldwide. For more information, visit
http://www.XpressPress.com
SOURCE American Association for the Study of Liver Diseases
Although
women
with
chronic
hepatitis
C virus
(HCV)
infection
are at
lower
risk for
developing
cirrhosis,
researchers
who
compared
outcomes
for men
and
women
after
having
liver
transplantation
found
that
women
have
a...
[read
article]
Small-for-size graft
dysfunction (SFSGD)
following
living-related liver
transplantation (LRLT)
is characterized by
early graft
dysfunction (EGD)
when the
graft-to-recipient
body weight ratio (GRBWR)
is below 0.8%...
[read
article]
Steve Jobs, co-founder and CEO of
Apple Inc. received a liver transplant in Tennessee about two months
ago, Wall Street Journal reported Friday. Jobs has been on medical
leave since January to treat a undisclosed medical condition. He has
reportedly been recovering well and is expected to return to work
soon.
Cited below is an article on liver
transplant from a U.S. government website for those who might be
interested in knowing more about the procedure.
Close to 20,000 Americans
are waiting for a liver
transplant - and some will
die before they get one. A
transplant is still the only
hope for anyone with
hepatitis C or liver cancer.
That's because developing
the right drugs to treat
liver disease has been a
struggle for researchers.
One nanotechnologist is
changing that.
"More than
27,000 people
die every year
from liver
disease while
only 6,000
receive new
livers. A new
artificial liver
may close this
gap.
May
View the latest transplant news
videos added to the internet and
find links to the latest news
stories!
How to use the Video Wall: To find out what each video is
about hover your mouse pointer over the video preview you want to
find out more about. After about a second, information about that
video will appear below it. To watch a video story, click the
preview to be taken to the viewing page for that particular video.
MELD and other predictors of
liver transplant survival
14 April 2009
This month’s
issue of Clinical Transplantation investigates MELD
and other predictors of survival after liver
transplantation.
Dr
Ajacio Brandão and colleagues from Brazil examined
how reliable the pre-transplant model is for end-stage liver
disease (MELD) score in predicting post-transplantation
survival.
In addition, the research team
analyzed variables associated with patient survival.
The team conducted a cohort study
using receiver operating characteristic curve c-statistics
to determine the ability of MELD score to predict mortality.
The Kaplan–Meier method was used to
analyze survival as a function of time regarding the MELD
score and Child-Turcotte-Pugh category.
The Cox model was employed to
assess the association between baseline risk factors and
mortality.
The researchers identified 436
transplants, and that recipients and donors were mostly
male, with a mean age of 52 and 39 years, respectively.
The c-statistic values for
three-month patient mortality were 0.60 and 0.61 for MELD
score and Child-Turcotte-Pugh category, respectively.
Kaplan–Meier survival at 3, 6 and
12 months were lower in those who had a MELD score of 21 or
were Child-Turcotte-Pugh category C.
Multivariate analysis revealed that
recipient age 65 years, MELD score of 21, Child-Turcotte-Pugh
C category, and a bilirubin level of 7 mg/dL were predictors
of mortality.
Creatinine levels of 1.5 mg/dL,
platelet transfusion, hepatocellular carcinoma, and
non-white color donor skin were also predictors of
mortality.
Dr Brandão’s team concluded,
“Severe pre-transplant liver disease, age 65 years,
non-white skin donor, and hepatocellular carcinoma are
associated with poor outcome.”
Post-liver transplant
survival in Hep C is improving
09 April 2009
Post-liver transplant survival in Hepatitis
C patients is improving over time, finds the
latest issue of Liver Transplantation.
Dr Jacqueline
O'Leary and colleagues from Texas,
USA found outcomes after orthotopic liver
transplantation for chronic Hepatitis C have
been reported to be worsening over the last
2 decades.
The team analyzed
our center's experience over 15 years to
identify trends in post-orthotopic liver
transplantation survival in patients with
and without Hepatitis C virus infection.
Patient survival
and graft survival among 1901 adult primary
orthotopic liver transplantation recipients
who survived more than 90 days from 1991 to
2006 at the Baylor Regional Transplant
Institute were evaluated by Kaplan-Meier
analysis.
Those with or without Hepatitis C virus
infection were analyzed by era.
Era 1 included 473
and spanned from 1991 to 1994, whereas era 2
had 421 patients and went from 1995 to 1998.
Era 3 spanned from
1999 to 2002 and included 498 patients, with
512 patients in Era 4 evaluated from 2003 to
2006.
The team assessed
differences in eras with disparate survivals
by univariate and multivariable analysis.
Overall, patient
survival and graft survival were
significantly lower among Hepatitis C virus
infection recipients compared to those
without Hepatitis C virus infection.
This difference was
dependent on the era of transplantation,
with progressive improvement in Hepatitis C
virus patient and graft survival in
sequential eras.
The researchers
found several factors accounted for this
improvement, notably better selection of
hepatocellular carcinoma patients and fewer
late cytomegalovirus infections.
The team noted that
improvement occurred despite an increase in
the ages of both donors and recipients.
Dr O'Leary's team
concluded, “Posttransplant survival after
orthotopic liver transplantation for chronic
Hepatitis C has improved significantly over
the last 15 years.”
“Despite
demographic changes in patients and grafts
that have been previously shown to impair
survival.”
“A major reason for
this improvement is better selection of
patients with concurrent hepatocellular
carcinoma and fewer late cytomegalovirus
infections, although other factors may play
a role as well.”
Risk factors
for early hepatic artery thrombosis after
transplantation
31 March 2009
The most recent issue of the American
Journal of Transplantation investigates
the incidence and risk factors of early
hepatic artery thrombosis after liver
transplantation.
Dr Bekker
and colleagues from the Netherlands
conducted a systematic review to identify
the incidence, risk factors and outcome of
early hepatic artery thrombosis after liver
transplantation.
The team searched
studies identified from databases including
MEDLINE, EMBASE, Science Citation Index, and
references of identified studies.
The team identified
71 studies out of 999 screened abstracts as
eligible for this systematic review.
The team found that
the incidence of hepatic artery thrombosis
was 4%.
In children, the
incidence of hepatic artery thrombosis was
8%, and 3% in adults.
Doppler ultrasound
screening protocols varied from 'no
routine' to 'three times a day.'
The median time to
detection was at day 7.
The team noted that
the overall retransplantation rate was 53%,
and was higher in children than in adults.
The overall
mortality rate of patients with hepatic
artery thrombosis was 33%.
The researchers
found that mortality in adults was higher
than in children.
The reported risk
factors for hepatic artery thrombosis
included cytomegalovirus mismatch, and
retransplantation.
Arterial conduits,
prolonged operation time, low recipient
weight, variant arterial anatomy, and low
volume transplantation centers were also
risk factors for hepatic artery thrombosis.
Hepatic artery
thrombosis is associated with significant
graft loss and mortality.
Dr Bekker’s team
concluded, “Uniform definitions of hepatic
artery thrombosis and uniform treatment
modalities are obligatory to confirm these
results and to obtain a better understanding
of this disastrous complication.”
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