J Korean Soc Transplant.  2012 Dec;26(4):269-276. 10.4285/jkstn.2012.26.4.269.

Liver Transplantation for Hepatitis C Virus-Related Liver Disease in Korea

• Lee HW
• Lee KW
• Kim BW
• Song GW
• Han YS
• Kwon CH
• Kim SH
• Choi GH
• Choi JY

• KMID: 2202430
• DOI: http://doi.org/10.4285/jkstn.2012.26.4.269

Abstract

BACKGROUND
A management protocol for hepatitis C virus (HCV) after liver transplantation (LT) has not been established in Korea. We therefore investigated HCV transplant protocols and post-transplant results from liver transplant centers in Korea.
METHODS
The HCV protocol and medical data of individual cases from eight major liver transplant centers were compiled and analyzed.
RESULTS
A post-transplant protocol biopsy was performed in only three centers. In these centers, HCV treatment was considered when pathological abnormalities were confirmed on the protocol biopsy (irrespective of liver function). In the other five centers, biopsies were performed when biochemical parameters were aggravated. Only two out of the eight centers performed preemptive or prophylactic therapy. A total of 5,663 adult LTs were performed between 2000 and 2010. HCV-related liver disease was responsible for 277 LTs (4.9%). Pre-transplant data were not available in many patients, including HCV genotype and serum HCV RNA level. Tacrolimus was more frequently used for initial maintenance immunosuppression than cyclosporine A (61.7% vs. 36.8%). Post-transplant HCV treatment was performed in 135 patients (48.7%). Sixty-seven recipients (24.2%) died during follow-up after LT and 11 HCV-related graft loss (4.0%) developed. The cumulative patient survival rate was 74.7% at 5 years and 67.9% at 10 years after LT.
CONCLUSIONS
The HCV management protocol after LT varied markedly between the eight Korean transplant centers and a standard protocol did not exist. A nationwide multicenter study is required to investigate the most effective treatment for HCV after LT, with the goal of establishing the most effective standard protocol.

Keyword

Hepatitis C virus; HCV recurrence; Liver transplantation; Prophylaxis

MeSH Terms

Adult
Biopsy
Cyclosporine
Follow-Up Studies
Genotype
Hepacivirus
Hepatitis
Hepatitis C
Humans
Immunosuppression
Korea
Liver
Liver Diseases
Liver Transplantation
RNA
Survival Rate
Tacrolimus
Transplants
Cyclosporine
RNA
Tacrolimus

Figure

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  Fig. 1 Annual proportion of liver transplantation for hepatitis C virus (HCV). The annual proportion of liver transplantation for HCV fluctuated during the study period, but largely showed gradual increasing pattern.

• 

  Fig. 2 Hepatitis C virus (HCV) genotypes. The most frequent HCV genotype was 1b (45.8%), followed by 2a (26.4%).

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  Fig. 3 Hepatitis C virus (HCV) treatment regimen. The most common HCV treatment regimen was the combination of pegylated interferon (Peg-IFN) and ribavirin (RIB). It was used in about half the cases before liver transplantation. However, it was far more frequently used in post-transplant treatment.

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  Fig. 4 The initial regimen of maintenance immunosuppressive therapy. Tacrolimus (TAC) was more frequently used for initial maintenance therapy than cyclosporine A (CSA). Mycophenolate mofetil (MMF) was added to calineurin inhibitors in patients of 67.9%. Corticosteroid was excluded in diagram because it was used in most patients.

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  Fig. 5 Cumulative patient survival of liver transplantation for hepatitis C virus. Cumulative patient survival rate was 74.7% at 5 years and 67.9% at 10 years after liver transplantation.

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