Perioperative Predictors of Survival After Liver Transplantation for Familial Amyloid Polyneuropathy in a Portuguese Center

BACKGROUND

Liver transplantation (LT) has been the treatment of choice to halt the progression of familial amyloid polyneuropathy (FAP). Few studies have identified prognostic factors for post-LT survival in FAP. Our aim was to assess survival rate and to identify independent factors for survival after LT.

METHODS

This retrospective cohort study of FAP patients transplanted for the first time analyzed 116 transplantations from 2006 to 2014. The median follow-up period was 45.5 months.

RESULTS

The overall survival rates at 1 month, 1 year, and 5 years were 89%, 82% and 79%, respectively. On multivariate analysis, only number of red blood cell (RBC) units transfused during surgery, operation time, and body mass index were independent prognostic factors for patient survival. Only 30% of patients were transfused during surgery, and, in these, each RBC unit transfused increased mortality by 53%. The operation time increased mortality by 20% for every 15 minutes of surgery.

CONCLUSIONS

This study suggests that operation time and RBC transfused are predominant factors affecting post-LT survival in our FAP patients.

[Familial infection by the hepatitis C virus]

The aim of this study was to evaluate the prevalence of the antibody to hepatitis C virus (HCV) in the relatives of cases of asymptomatic chronic hepatitis C infection, detected during routine blood donation, and determine risk factors for the presence of the infection in the family setting. Two hundred and eighty-five relatives (spouses, offspring, siblings and parents) of 87 index cases were studied. Anti-HCV was detected using second generation ELISA and RIBA tests. The overall prevalence of anti-HCV in the studied population was 6.7%, higher in spouses (11.7%) and lower in the offspring (2.1%). The presence of HCV RNA was detected in 12 of 45 index cases, using nested PCR. No increased risk of infection was found in the relatives of cases with HCV-RNA positivity. Using a logistic regression model, four factors were identified as significantly associated with an increased risk of hepatitis C in the relatives: the age of the index case, and, as characteristics of the relatives, male gender, past or ongoing hepatitis B virus infection, and being a spouse of an index case.

Hepatitis C virus antibodies in asymptomatic chronic carriers of hepatitis B surface antigen

The objectives of the study were to evaluate the prevalence, incidence and clinical significance of antibodies to hepatitis C virus in HBsAg chronic carriers. The evaluation of stored sera was combined with the follow up of a cohort of cases observed in a referral-based university hospital. A total of 183 HBsAg asymptomatic chronic carriers were identified during routine screening and followed for a mean period of 3.8 years. Stored sera and sera obtained during follow-up were tested for anti-HCV using ELISA. Second-generation RIBA (Ortho) was used as a possible confirmatory test. Demographic data and risk factors were assessed using a standard questionnaire. The prevalence of HCV infection in HBsAg chronic carriers was 2.7% (95% Cl: 1.2%-63%), higher in males than females (3.1% vs 1.8%, p = 0.52) and also higher than that found in voluntary blood donors from the same region. Only 3 out of 5 ELISA-positive cases were RIBA-positive. Patients positive for both types of virus more frequently admitted drug abusers. The presence of anti-HCV was not significantly related to the histological severity. During follow-up no new cases of infection were found.

CONCLUSIONS

The prevalence of HCV infection in asymptomatic chronic carriers is higher than in blood donors but lower than previously reported for other populations of chronic hepatitis B cases. HCV infection was not found responsible for the frequency or the type of lesions observed in these HBsAg chronic carriers.

[Hepatitis C virus infection in chronic asymptomatic carriers of HBs antigen]

The objectives of the study were to evaluate the prevalence, the incidence and the clinical significance of antibodies to hepatitis C virus in HBsAg chronic carriers. The evaluation of Stored sera was combined with the follow-up of a cohort os cases observed in a referral-based university hospital. A total of 183 HBsAg asymptomatic chronic carriers were identified during routine screening and followed for a mean period of 3.8 years. Stored sera and sera obtained during follow-up were tested for anti-HCV using ELISA. Second generation RIBA (Ortho) was used as a possible confirmatory test. Demographic data and risk factors were assessed using a standard questionnaire. The prevalence of HCV infection in HBsAg chronic carriers was 2.7% (95% CI: 1.2%-6.3%), higher in male than female (3.1% vs 1.8%, p = 0.52) and also higher than the one found in voluntary blood donors from the same region. Only 3 out of 5 ELISA-positive cases were RIBA-positive. Patients positive for both types of virus more frequently admitted drug abuse. The presence of anti-HCV was not significantly related to the histologic severity. During follow-up no new cases of infection were found.

CONCLUSIONS

The prevalence of HCV infection in asymptomatic chronic carriers is higher than in blood donors but lower than previously reported for other populations of chronic hepatitis B cases. HCV infection was not found responsible for the frequency or the type of lesions observed im these HBsAg chronic carriers.