Objective: Four million Americans are infected with Hepatitis C virus (HCV) and HCV has become the most common indication for liver transplantation (OLT). Graft reinfection remains a universal phenomenon but only some recipients progress to rapid graft loss. The factors underlying aggressive recurrence are undefined. This study examines the impact of donor, recipient, and operative variables in order to identify factors that will predict HCV recurrence.
Methods: Retrospective review of 307 patients who underwent OLT for HCV at our center over a 10 year period. Recurrence of HCV was diagnosed by liver biopsy. Four donor, 5 recipient, and 2 operative variables were analyzed by univariate comparison and Cox proportional hazard regression models.
Results: Recurrence free survival in the 307 study patients was 69% and 37% at 1 and 5 years. Significant predictors of recurrence included donor, perioperative, and recipient variables. As shown below the Relative Risk (RR) of HCV recurrence increased with advanced donor age, prolonged donor hospitalization, extended cold or warm ischemia times (WIT), and urgent recipient status. HLA mismatch between donor and recipient demonstrated no correlation with recurrence-free survival.

Conclusions: We have identified donor, recipient, and operative factors that significantly predict Hepatitis C recurrence following liver transplant. These factors, with the exception of WIT, are identifiable pre-transplant and if taken into consideration when matching the donor to the HCV recipient would decrease the incidence of recurrent HCV after OLT. To fully capitalize on this benefit, a change in the current national liver allocation system must be made.