Hepatitis C impairs survival following liver transplantation irrespective of concomitant hepatocellular carcinoma

Background/Aims Liver transplantation (LTX) is the only curative treatment for end-stage liver disease caused by hepatitis C (HCV). Hepatocellular carcinoma (HCC) is common in patients with HCV cirrhosis. Methods Two hundred and eighty-two HCV patients listed for LTX in the Nordic countries in a 17-year period were included. For comparison a group of patients with non-viral chronic liver disease (n = 1552) was used. Results Two hundred and fifty-three (90%) patients received a first liver allograft. HCC was found in 38% of the explanted livers. Survival at 1, 3 and 5 years was 82%, 69% and 61% vs. 85%, 80% and 76% for the comparison group (p < 0.0001), this survival difference was also evident when excluding patients with HCC (p = 0.007). HCV patients with HCC had 1, 3 and 5 year survival of 73%, 52% and 46% compared with 88%, 80% and 71% for the HCV patients without HCC (p = 0.0005). In an intention-to-treat analysis (from time of acceptance to the waiting list) HCV was also associated with an impaired survival. Conclusions HCV cirrhosis, which is now also an important indication for LTX in the Nordic countries, and significantly impairs survival following LTX. Concomitant HCC and donor age are the two most important factors contributing to an impaired survival.