Outcome
Previous Intravenous Substance Use and Outcome of Liver Transplantation in Patients With Chronic Hepatitis C Infection

https://doi.org/10.1016/j.transproceed.2009.01.003Get rights and content

Abstract

Background

End-stage liver disease due to hepatitis C viral (HCV) infection is the most common reason for liver transplantation. One of the major risk factors for infection with HCV is intravenous drug use (IVDU). The pretransplantation characteristics and outcome of liver transplantation in patients with chronic hepatitis C (CHC) infected after IVDU are poorly known.

Methods

We performed a retrospective cohort study in patients with CHC who underwent liver transplantation between 1998 and 2002 in Belgium. Seven patients with and 60 patients without a history of IVDU were compared.

Results

Patients with CHC infected after IVDU were primarily men, significantly younger, and affected more by genotype 2 or 3. There was no relapse in substance use. No patients required a second transplantation or developed surgical complications. Progression to fibrosis in the posttransplantation period seemed to be slower. Graft and patient survival, and compliance were similar in both groups.

Conclusions

Compared with patients in the non-IVDU group, patients with CHC infected after IVDU in complete remission have the same compliance, and patient and graft survival after liver transplantation. Therefore, patients with IVDU should not be excluded for liver transplantation because of HCV-induced cirrhosis.

Section snippets

Materials and Methods

This retrospective cohort study included all HCV-positive patients who underwent liver transplantation between December 1998 and January 2002 in three transplant units in Belgium. Patients with and without a history of IVDU were compared. Follow-up was to the beginning of 2006.

Included in the study were patients who underwent a first liver transplantation because of end-stage liver disease due to CHC viral infection. Patients were considered intravenous substance users when infected after IVDU.

Demographic and Pretransplantation Characteristics of the Study Population

Overall, 67 patients underwent a first liver transplantation during the study. Seven patients (10%) had a documented history of substance abuse before transplantation (group 1), and 60 patients had no evidence of substance abuse (group 2). Patients with a history of substance abuse were all infected after needle and paraphernalia sharing during intravenous drug use. In the non-IVDU group, some were infected by transfusion (10%) or tattoo (2%). However, in most of those patients (88%), the

Discussion

In recent years, substance use has become the major risk factor for infection with HCV. More patients with a history of substance use are being treated at liver transplant centers. Although for patients in a methadone maintenance program a 6-month abstinence period is required,6 no comparative data about the long-term outcome of liver transplantation in substance users in prolonged complete remission are available.

To our knowledge, this is the first comparative study of posttransplantation

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