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

Abstract

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.

Liver allografts from hepatitis C positive donors can offer good outcomes in hepatitis C positive recipients: a US National Transplant Registry analysis

“…Three-year graft survival rates were similar among both patient populations [13]. Other more recent small trials have continued to support the notion of using HCV+ grafts in HCV+ recipients without major clinical detriment [14,15]. The purpose of this study is to investigate the long-term effect of liver transplantation using HCV+ donors including data from the modern era of organ allocation, transplantation and immunosuppression.…”

Strategies to reduce hepatitis C virus recurrence after liver transplantation

“…Demonstrating a negative impact of older donor age (> 50 years) on survival and fibrosis progression in patients transplanted with HCV+ organs. According to the current evidence, using HCV+ grafts from young donors (< 50 years) for HCV recipients can produce good results, but further experience is required to establish the validity of this approach [65] . The influence of co-infections on HCV recurrence has been investigated by a number of groups.…”

Hepatitis C virus superinfection of liver grafts: a detailed analysis of early exclusion of non-dominant virus strains

“…One approach to expand the pool of organs for transplantation is to use grafts from extended-criteria donors, such as HCV-positive donors. Several studies have reported no differences in outcomes with the use of HCV-positive grafts in comparison with the use of non-infected grafts (Marroquin et al, 2001;Vargas et al, 1999;Velidedeoglu et al, 2004), although donor age has recently been recognized to play an important role after transplantation with HCV-positive grafts (Khapra et al, 2006). In addition, it is important to note that grafts from genotype 1 donors should not be allocated to recipients infected with genotypes 2 or 3, in which antiviral therapy is significantly more effective than for genotype 1, and the introduction of the latter genotype may be detrimental for the patient's outcome.…”