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HCV patients survival after liver transplantation is not improving

tudy period, in contrast to the latter group.

"In summary, the survival of patients transplanted with HCV is significantly lower than those without HCV," the authors report. "There has been a statistically significant improvement in patient and graft survival for non-HCV recipients between 1991 and 2001, but for HCV recipients, the survival rate has remained unchanged without any obvious explanations."

Another article in the same issue of Liver Transplantation by Luca Belli of Niguarda Hospital in Milan includes observations from another group of HCV positive patients who received liver transplants between January 1990 and December 2002. They noted a trend for better patient survival in recent years, "but the cumulative probability of developing severe recurrent disease remained unchanged," the authors report. They pinpointed the combination of a female recipient receiving an old graft as a strong risk factor for a severe recurrence.

An accompanying editorial by Marina Berenguer of Hospital La Fe in Valencia, Spain considers the conflicting data from these studies and others that came before and suggests that advanced donor age together with steroid pulse therapy and over immunosuppression can explain differences in outcomes. "The association with worse outcomes in recent years, and the controversy that seems to surround this observation, is likely due to differences in distribution of these variables from study to study, from center to center, and from year to year."

For future studies, she suggests that researchers use large databases to identify trends in liver transplantation, or that they perform studies comparing different management strategies. In the absence of effective antivirals, she concludes, "we are obliged to make sure through a better understanding of factors associated with outcome that we are minimizing harm to patients with our current management strategies."


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Contact: Amy Molnar
amolnar@wiley.com
John Wiley & Sons, Inc.
2-May-2007


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