Role of Preoperative Viral Load and Presence of Hepatocellular Carcinoma in the Biliary Complications After Liver Transplantation Due to Hepatitis C Virus |
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| Institution: | 1. Sisli Florence Nightingale Hospital, Liver Transplantation Institute, Hospital of Istanbul Bilim University, Istanbul, Turkey;2. Sisli Florence Nightingale Hospital, Infectious Diseases Department, Hospital of Istanbul Bilim University, Istanbul, Turkey;3. Sisli Hamidiye Etfal Training And Research Hospital, Department of General Surgery, Istanbul, Turkey;1. Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada;2. Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada;3. Division of Cardiac Surgery, University of British Columbia, Vancouver, British Columbia, Canada;1. Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea;2. Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, South Korea;3. School of Computer Science and Engineering, Soongsil University, Seoul, South Korea;4. Division of Liver Transplantation and Hepatobiliary Surgery, Departments of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea;1. Divisions of Vascular and Interventional Radiology, Duke University Medical Center, Box 3808, 2311 Erwin Rd., Durham, NC 27710;2. Gastroenterology, Duke University Medical Center, Box 3808, 2311 Erwin Rd., Durham, NC 27710 |
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| Abstract: | BackgroundChronic hepatitis C virus (HCV) infection is a global health problem, and the need for liver transplants is ever-growing. For optimal surgical success, risk factors must be identified and HCV viral load must be reduced to a minimum to avoid complications. In this study, we aimed to investigate the role of HCV viral load on the post-transplant biliary complications.MethodBetween 2004 and 2018, the cases of 114 liver transplant recipients with HCV infection were retrospectively reviewed. Data collection included demographic variables, preoperative and postoperative amount of serum HCV RNA copies, preoperative diagnosis of hepatocellular carcinoma (HCC), and postoperative biliary complications in the early and late period. After missing values were excluded, the remaining 97 patients were divided into 2 groups according to preoperative HCV RNA status (Group A: HCV RNA +] and Group B: HCV RNA -]).ResultsDemographic parameters were similar among both groups. There were 67 patients in Group A and 30 patients in Group B. The overall rate of biliary complications was higher in Group A without statistical significance (20% n = 14] vs 13% n = 4], respectively, P = .573). Biliary stricture occurrence in the late period was also higher in Group A. In HCC (+) patients (n = 26), biliary complications were significantly higher compared to HCC (-) patients (34% vs 12%, P = .018). However, in patients with biliary complications, the rate of multiple duct anastomoses was higher with no statistical significance (45% vs 26%, respectively, P = .14).ConclusionThe biliary complications on patient survival has been previously established, and this is mostly evident in those patients with viral etiology and hepatocellular carcinoma. As was also suggested in our study, hepatocellular carcinoma and positive viral status should be considered as predisposing factors for postoperative biliary complications after liver transplantation. However, the rate of multiple duct anastomoses should also be taken into consideration. New standards of antiviral medications and bridge therapy for HCC may improve transplant outcomes. |
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