Donor age affects fibrosis progression and graft survival after liver transplantation for hepatitis C1

Machicao, Victor I.; Bonatti, Hugo; Krishna, Murli; Aqel, Bashar; Lukens, Frank; Nguyen, Justin H.; Rosser, Barry G.; Satyanarayana, Raj; Grewal, Hani P.; Hewitt, Winston R.; Harnois, Denise M.; Crook, Julia E.; Steers, Jeffery L.; Dickson, Rolland C.

doi:10.1097/01.tp.0000095896.07048.bb

Cited by 149 publications

(146 citation statements)

References 30 publications

(36 reference statements)

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“…identified donor age higher than 60 years as a risk factor for developing cirrhosis [HR = 1.02 (1.008-1.05)] and worse graft survival [HR = 1.05 (1.03-1.07)]. Other studies have demonstrated a relationship between accelerated fibrosis and poorer outcome in grafts from older donors [41,42] . Machicao et al [41] and Wali et al [42] reported that donors aged 50 years or more, had a median fibrosis progression rate of 2.7 units/year and time to cirrhosis of 2.2 years post transplant.…”

Section: Donor Agementioning

confidence: 90%

“…Other studies have demonstrated a relationship between accelerated fibrosis and poorer outcome in grafts from older donors [41,42] . Machicao et al [41] and Wali et al [42] reported that donors aged 50 years or more, had a median fibrosis progression rate of 2.7 units/year and time to cirrhosis of 2.2 years post transplant. In contrast, Samonakis et al [43] found that absence of maintenance steroids and azathioprine but not donor age influenced severity of HCV recurrence.…”

Section: Donor Agementioning

confidence: 99%

See 1 more Smart Citation

Strategies to reduce hepatitis C virus recurrence after liver transplantation

Ciria

Pleguezuelo²,

Khorsandi³

et al. 2013

WJH

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Hepatitis C virus (HCV) is a major health problem that leads to chronic hepatitis, cirrhosis and hepatocellular carcinoma, being the most frequent indication for liver transplantation in several countries. Unfortunately, HCV re-infects the liver graft almost invariably following reperfusion, with an accelerated history of recurrence, leading to 10%-30% of patients progressing to cirrhosis within 5 years of transplantation. In this sense, some groups have even advocated for not retransplanting this patients, as lower patient and graft outcomes have been reported. However, the management of HCV recurrence is being optimized and several strategies to reduce post-transplant recurrence could improve outcomes, decrease the rate of re-transplantation and optimize the use of available grafts. Three moments may be the focus of potential actions in order to decrease the impact of viral recurrence: the pretransplant moment, the transplant environment and the post-transplant management. In the pre-transplant setting, it is not well established if reducing the pre transplant viral load affects the risk for HCV progression after transplant. Obviously, antiviral treatment can render the patient HCV RNA negative post transplant but the long-term benefit has not yet been fully established to justify the cost and clinical risk. In the transplant moment, factors as donor age, cold ischemia time, graft steatosis and ischemia/reperfusion injury may lead to a higher and more aggressive viral recurrence. After the transplant, discussion about immunosuppression and the moment to start the treatment (prophylactic, pre-emptive or once-confirmed) together with new antiviral drugs are of interest. This review aims to help clinicians have a global overview of posttransplant HCV recurrence and strategies to reduce its impact on our patients.

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Section: Donor Agementioning

confidence: 90%

Section: Donor Agementioning

confidence: 99%

Strategies to reduce hepatitis C virus recurrence after liver transplantation

Ciria

Pleguezuelo²,

Khorsandi³

et al. 2013

WJH

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show abstract

“…Information from prior studies of grafts from HCVϪ donors has shown that HCV recurrence is almost universal when patients are transplanted for HCV and that certain characteristics such as donor age portend worse clinical outcomes. 17,23,24 No study has evaluated the impact of specific clinical characteristics of the donor allograft on survival outcomes in recipients of HCVϩ donor transplants, nor has a study previously evaluated fibrosis progression post-liver transplantation in this group of patients.…”

Section: Discussionmentioning

confidence: 99%

“…More recently, donor age Ն50 yr has specifically been found to have a negative impact on both patient and graft survival as well as accelerating fibrosis progression and the progression to cirrhosis. [16][17][18] There have been no studies to date examining the impact of donor age on liver transplantation using HCVϩ donor livers.…”

mentioning

confidence: 99%

Impact of donor age on survival and fibrosis progression in patients with hepatitis C undergoing liver transplantation using HCV+ allografts

et al. 2006

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Studies have suggested that the use of hepatitis C virus (HCV)-positive (HCVϩ) donor allografts has no impact on survival. However, no studies have examined the effect that HCVϩ donor histology has upon recipient and graft survival. We evaluated the clinical outcome and impact of histological features in HCV patients transplanted using HCVϩ livers. We reviewed all patients transplanted for HCV at our institution from 1988 to 2004; 39 received HCVϩ allografts and 580 received HCVnegative (HCVϪ) allografts. Survival curves compared graft and patient survival. Each HCVϩ allograft was stringently matched to a control of HCVϪ graft recipients. No significant difference in survival was noted between recipients of HCVϩ livers and controls. Patients receiving HCVϩ allografts from older donors (age Ն50 yr) had higher rates of graft failure (hazard ratio, 2.74) and death rates (hazard ratio, 2.63) compared to HCVϪ allograft recipients receiving similarly-aged older donor livers. Matched case-control analysis revealed that recipients of HCVϩ allografts had more severe fibrosis post-liver transplantation than recipients of HCVϪ livers (P ϭ 0.008). More advanced fibrosis was observed in HCVϩ grafts from older donors compared to HCVϩ grafts from younger donors (P ϭ 0.012). In conclusion, recipients of HCVϩ grafts from older donors have higher rates of death and graft failure, and develop more extensive fibrosis than HCVϪ graft recipients from older donors. Recipients of HCVϩ grafts, regardless of donor age, develop more advanced liver fibrosis than recipients of HCVϪ grafts.

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“…Donor age seems to influence graft survival only in HCVpositive patients. However, there is little chance that this will change, since very few transplant programs are able to pair younger donors with HCV-positive receptors [11,12].…”

Section: Donor and Receptor Factorsmentioning

confidence: 99%