Outcome of orthotopic liver transplantation in patients with haemophilia

Abstract

Background: Many patients with haemophilia have developed cirrhosis or hepatocellular carcinoma due to transfusion acquired chronic viral hepatitis.

Aims: To assess the long term outcome of all haemophilic patients reported to have undergone orthotopic liver transplantation.

Methods: Transplant centres of patients identified by medical database search were contacted and survival data assessed by Kaplan-Meier analysis.

Results: Twenty six haemophilic men (median age 46 years, range 5-63 years) underwent orthotopic liver transplantation in 16 centres between 1982 and 1996. Indications for transplantation were hepatitis C cirrhosis (69%), hepatitis B with or without C cirrhosis (15%), viral hepatitis related hepatocellular carcinoma (12%), and biliary atresia (4%). Six patients (23%) were infected with human immunodeficiency virus (HIV). Postoperatively, the median time to normal clotting factor levels was 24 hours (range 0-48 hours) and exogenous clotting factors were stopped at a median of 24 hours (range 0-480 hours). Four patients (15%) had bleeding complications. The one and three year survival of HIV positive recipients (67% and 23%) was significantly poorer (p = 0.0003) than that of HIV negative recipients (90% and 83%). Coagulopathy was cured in all patients surviving more than 12 days post-transplant. Six of the 20 patients (30%) with hepatitis C cirrhosis pretransplant had evidence of disease recurrence at a mean of nine months post-transplant.

Conclusions: Hepatitis C cirrhosis is the most common indication for orthotopic liver transplantation in patients with haemophilia. Transplantation results in long term cure of haemophilia but may be complicated by the effects of HIV infection or recurrent viral hepatitis.

Figure 1

Kaplan-Meier survival probability plot of 26 haemophilic orthotopic liver transplant recipients. Continuous line indicates HIV negative recipients; dotted line indicates HIV positive recipients.

Figure 2

Serial CD4+ lymphocyte counts of HIV positive patient 19 before and after transplantation.

Figure 3

Serial CD4+ lymphocyte counts of HIV positive patient 22 before and after transplantation.