Negativization of viremia prior to liver transplant reduces early allograft dysfunction in hepatitis C recipients

Although early allograft dysfunction (EAD) negatively impacts on survival from the first months following liver transplantation (LT), direct-acting antivirals (DAAs) have revolutionized HCV therapy. We investigated the EAD definition best predicting 90-day graft loss and identified EAD risk factors in HCV positive recipients. From 11-2002 to 06-2016, 603 HCV-positive patients (hepatocellular carcinoma 53.4%) underwent a first LT with HCV-negative donors. Median recipient MELD score 15, median donor age 63 years. At LT, 77 (12.8%) patients were HCV RNA negative; negativization was achieved and maintained by pre-LT antiviral therapy (61 patients) or pre-LT+pre-emptive post-LT course (16 patients); 60 (77.9%) patients received DAAs and 17 (22.1%) interferon. We compared three different EAD definitions: a) bilirubin≥10 mg/dL or INR≥1.6 on day 7 post-LT or AST or ALT>2000 IU/L within 7 days of LT; b) bilirubin>10 mg/dL on days 2 to 7 post-LT; c) MELD≥19 on day 5 post-LT. EAD defined by MELD≥19 on day 5 post-LT had the lowest negative (0.1) and the highest positive (1.9) likelihood ratio to predict 90-day graft loss. At 90 days post-LT, 9.2% of recipients with EAD lost their graft as opposed to 0.7% of those without EAD (p<0.001). At multivariate analysis, considering variables available at LT, MELD at LT>25 (OR=7.4) or 15-25 (OR=3.2), graft macrovesicular steatosis≥30% (OR=6.7), HCV RNA positive at LT (OR=2.7), donor age>70 years (OR=2.0), earlier LT era (OR=1.8), cold ischemia time≥8 hours (OR=1.8) were significant risk factors for EAD.