The author retrospectively evaluated the outcome of the Hungarian Liver Transplant program from 1995 to 2006. Liver transplants in the context of HCV positive cirrhosis were analysed separately. Furthermore, fulminant recurrence of HCV infection in the implanted graft was also investigated. The possible association among the serum titer of the HCV RNA, the histological patterns, the clinical course and the expression of the endoplasmatic chaperones in HCV graft biopsies (which is responsible for the endoplasmatic stress response) was also investigated. The number of liver transplants showed a four-fold yearly increase in the last 10 years. The 1, 3 and 5 years cumulative patient survival were 55%, 45% and 39% (1995-1997), 72%, 64% and 61% (1998-2000), and 78%, 77% and 77% (2001-2004), respectively. Total mortality decreased from 53% to 31%, mortality within 60 days decreased from 24% to 5%. Cumulative survival for HCV positive patients was respectively 64%, 55% and 51%, versus other chronic indications, which was 73%, 66% and 63%, respectively. Virus recurrence was 43% within 1 year. Factors with an impact on patient survival were calculated with Cox-regression multivariate analysis: postoperative kidney failure, hepatic artery thrombosis, biliary necrosis, cholangitis, pulmonary infection, abdominal infection, amount of intraoperative colloid use and transfusions. All chaperones (XBP1, ATF6, HSP70, GRP98, GP96, Calnexin and Calreticulin) were upregulated in the graft biopsies of HCV positive patients, irrespectively of the serum HCV-RNA titer. This upregulation decreased significantly after 1 year of interferon treatment. In case of acute rejection, upregulation of all chaperones was significantly higher than in HCV recurrence. An association was demonstrated between the serum HCV-RNA titer and the early recurrence. An RNA cut off point was identified to predict unfavourable histological and clinical prognosis, and a worse survival as well.
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