Survival in patients with Child-Pugh class C cirrhosis: Analysis of the liver transplant registry in Japan

Takuya Genda; Takafumi Ichida; Shotaro Sakisaka; Eiji Tanaka; Satoshi Mochida; Yoshiyuki Ueno; Ayano Inui; Hiroto Egawa; Koji Umeshita; Hiroyuki Furukawa; Seiji Kawasaki; Yukihiro Inomata; Assessment Committee of Indication for Transplantation

doi:10.1111/hepr.12855

Survival in patients with Child-Pugh class C cirrhosis: Analysis of the liver transplant registry in Japan

Hepatol Res. 2017 Oct;47(11):1155-1164. doi: 10.1111/hepr.12855. Epub 2017 Jan 26.

Affiliations

¹ Department of Gastroenterology and Hepatology, Juntendo University Shizuoka Hospital, Izunokuni, Japan.
² Department of Hepatology, East Shonan General Hospital, Kanagawa, Japan.
³ Department of Gastroenterology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
⁴ Department of Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
⁵ Department of Gastroenterology and Hepatology, Saitama Medical University, Saitama, Japan.
⁶ Department of Gastroenterology, Yamagata University Faculty of Medicine, Yamagata, Japan.
⁷ Division of Hepatology and Gastroenterology, Department of Pediatrics, Eastern Yokohama Hospital, Yokohama, Japan.
⁸ Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
⁹ Department of Surgery, Osaka University Graduate School of Medicine, Suita, Japan.
¹⁰ Department of Gastroentrologic and General Surgery, Asahikawa Medical University, Asahikawa, Japan.
¹¹ Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
¹² Department of Transplantation and Pediatric Surgery, Postgraduate School of Medical Science, Kumamoto University, Kumamoto, Japan.

PMID: 27995739
DOI: 10.1111/hepr.12855

Abstract

Aim: To clarify the survival and prognostic factors in patients with Child-Turcotte-Pugh class C (CTP-C) cirrhosis.

Methods: From all candidates for deceased donor liver transplantation in Japan between 2007 and 2015, 1014 adult patients with CTP-C cirrhosis were retrospectively enrolled in this study. The hazard ratio (HR) of factors associated with mortality was estimated by the Cox proportional hazard model. The survival probabilities were evaluated by Kaplan-Meier analysis and the log-rank test.

Results: Median survival time of the entire cohort was 475 days. Univariate analysis identified age, CTP, Model for End-Stage Liver Disease (MELD) score, and primary biliary cholangitis (PBC) as significant variables associated with mortality and hepatitis B virus (HBV) infection as a close-to-significant variable. Multivariate analysis revealed that age-adjusted mortality risk increased by 59% and 12% per 1 score step up in CTP and MELD scores, respectively. The HRs for HBV infection and PBC were significant after adjustment for age and CTP score, and they showed a 26% lower risk and an 83% higher risk than hepatitis C virus (HCV) infection, respectively. After adjustment for age and MELD score, the HR was also significant for HBV infection, but lost statistical significance for PBC. The survival curves were well stratified by both CTP or MELD score and revealed significant difference in both HBV infection and PBC as compared to HCV infection.

Conclusions: In patients with CTP-C cirrhosis, CTP and MELD scores could well stratify the patients' survival, and HBV infection and PBC as etiologies have an impact on survival.

Keywords: End-stage liver disease; hepatitis B virus; hepatocellular carcinoma; primary biliary cirrhosis.