Intravenous substance use and the outcome of liver transplantation for chronic hepatitis C

Abstract

Background and Aims: Although patients with previous intravenous drug use(IVDU) are not excluded from orthotopic liver transplantation(OLT), there is still concern about their outcome. The number of publications concerning this topic is limited(Kanchana TP et al, 2002; Liu et al, 2003; Murray KF et al, 2005) and no studies directly comparing the outcome of previous IVDU and non-IVDU are available. Methods: To compare pre-transplantation characteristics and transplantation outcome in chronic hepatitis C (CHC) patients infected after substance use with patients infected by other causes, we performed a retrospective, controlled study including all patients who underwent a live transplantation between December 1998 and January 2002 in Belgium. Results: In this study period 10% of all CHC patients who underwent liver transplantation(n = 67) were infected due to IVDU. IVDU CHC patients in comparison with non-IVDU patients were mainly males, were significantly younger and more patients suffered from genotype 2 and 3 (57% vs. 15%, p = 0.05). There was no difference in waiting time for transplantation, cold and warm ischemia time. Patient (p = 0.7) and graft (p = 0.4) survival were similar. Previous IVDU patients had less major surgical complications and none of them needed retransplantation in contrast to 10% of the non-IVDU patients (0 vs. 10%, p = 1.0). They had a tendency to evolve less frequently to major fibrosis (2 (29%) vs. 32 (67%); p = 0.09) and were less frequently treated (0 (0%) vs. 18 (35%); p = 0.09) with antiviral treatment in the post transplant period. The compliance was as good as the other CHC patients and no relapse in substance use could be documented. Conclusions: CHC patients infected after substance abuse have the same patient and graft survival and compliance after liver transplantation. Evolution to fibrosis in the post-transplantation period seems to be slower and treatment with antivirals is less frequently needed in comparison with other CHC patients, which might be due to the fact that most of the patients were younger than 50 years and received a donor liver that was less than 50 years old. Therefore these patients should not be excluded for liver transplantation for HCV cirrhosis.