ReTransplantation for Hepatitis C CON

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Re-Transplantation for Hepatitis CCON

• J. Michael Millis, M.D.
• Julian E. Lozanov, M.D.
• University of Chicago

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Assumptions

• 1) For the foreseeable future, therapies for
  Hepatitis C are not significantly more effective
  for Hepatitis C than the current regimen.
• 2) Primary transplants for Hepatitis C continue
  to be performed
• 3) The severity of recurrent disease does not
  change with immunosuppressive advances

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Hepatitis C and Re -Tx

• 5000 Tx performed annually
• 40 for Hep C
• 20-40 of those recurrent cirrhosis within 5 yrs
  and need Re transplantation
• Longer term data even more discouraging (Rosen
  AALSD (2004)
• 600 patients transplanted a year will develop
  cirrhosis
• Over a decade this will consume an entire year of
  transplants

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Hepatitis C, MELD, and Post Transplant Survival

• Data -
• Re transplantation 2nd highest predictor for Post
  transplant death (RR 2.19)
• Recurrent Hepatitis C patients with MELD gt 25 who
  are transplanted have a 5 yr survival of 29
  compared to 80 for primary transplants
• 40 of Transplants are performed with MELDs gt25

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Hepatitis C, MELD, and Post Transplant Survival

• Assumptions
• Primary Transplants
• MELD gt25 (comprise 40 of transplants)
• 80 5 yr survival
• 1600 of the 2000 patients transplanted (40 of
  5000) will be alive
• VERSES
• 580 of the 2000 patients transplanted (40 of
  5000) if all 2000 were recurrent Hepatitis C

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Hepatitis C, MELD, and Post Transplant Survival

• 1020 patients will be alive if we exclude
  Recurrent Hep C patients from being re-
  transplanted

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Re-Transplantation for Hep CSelf Selection of
the No Option in the MELD Era
31
9
28
7
122
118
106
100
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Re-Transplantation for Hepatitis CCON

• We are already saying no, otherwise the of
  re- transplants for Hep C would be rising rather
  than decreasing
• Regardless of how you vote with your hands, you
  are voting NO with your clinical decisions.