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

Mount Sinai Medical Center, New York, New York, United States
Liver Transplantation (Impact Factor: 4.24). 10/2006; 12(10):1496-503. DOI: 10.1002/lt.20849
Source: PubMed


Studies have suggested that the use of hepatitis C virus (HCV)-positive (HCV+) donor allografts has no impact on survival. However, no studies have examined the effect that HCV+ donor histology has upon recipient and graft survival. We evaluated the clinical outcome and impact of histological features in HCV patients transplanted using HCV+ livers. We reviewed all patients transplanted for HCV at our institution from 1988 to 2004; 39 received HCV+ allografts and 580 received HCV-negative (HCV-) allografts. Survival curves compared graft and patient survival. Each HCV+ allograft was stringently matched to a control of HCV- graft recipients. No significant difference in survival was noted between recipients of HCV+ livers and controls. Patients receiving HCV+ allografts from older donors (age > or =50 yr) had higher rates of graft failure (hazard ratio, 2.74) and death rates (hazard ratio, 2.63) compared to HCV- allograft recipients receiving similarly-aged older donor livers. Matched case-control analysis revealed that recipients of HCV+ allografts had more severe fibrosis post-liver transplantation than recipients of HCV- livers (P = 0.008). More advanced fibrosis was observed in HCV+ grafts from older donors compared to HCV+ grafts from younger donors (P = 0.012). In conclusion, recipients of HCV+ grafts from older donors have higher rates of death and graft failure, and develop more extensive fibrosis than HCV- graft recipients from older donors. Recipients of HCV+ grafts, regardless of donor age, develop more advanced liver fibrosis than recipients of HCV- grafts.

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Available from: Sukru Emre, Oct 03, 2014
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    • "No effect of donor age on survival could be detected in our present cohort. However, the overall donor age was relatively high throughout the entire study period (median 54 years, range 11–77), compared to other transplant centers [14] [31] [32] and the low number of young donors may have led to an underestimation of the effect of donor age. In order to assess the importance of donor histology in older donors, we evaluated the impact of stage of fibrosis, steatosis, and necroinflammatory activity on graft and patient survival in recipients receiving a liver from a donor aged 60 years or more. "
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    ABSTRACT: Survival following liver transplantation for hepatitis C virus (HCV) infection is affected by several factors. The aims of this single-center study were to evaluate survival from 1992 to 2006 in HCV-infected liver transplant recipients and to identify factors influencing patient and graft survival, with particular focus on donor liver histopathology. Survival among 84 patients transplanted for HCV-related liver disease at the Sahlgrenska University Hospital during the above period was evaluated. Median follow-up time was 57 months (range 28-87). A perioperative liver biopsy from the donor liver graft was available in 68 cases. Biopsies were assessed for fibrosis, necroinflammatory activity, and degree of steatosis. Patient and graft survival according to relevant factors including donor histopathology were analyzed by Kaplan-Meier analysis. We found an association between donor liver fibrosis and patient survival (p = 0.016) as well as between graft survival and portal inflammation in the donor liver (p = 0.026). Both these associations remained significant in multivariate analysis (p = 0.007 and 0.017 respectively). Moreover, recipient age over 60 was found predictive of patient survival and repeated steroid boluses or steroid-resistant rejection of graft survival. Donor age was high throughout the study period. Histopathological features, especially portal inflammation and stage of fibrosis, in the donor liver may deleteriously affect graft and patient survival following HCV-related liver transplantation. Thus, pretransplant evaluation of donor histopathology may be of value in the selection of donors for transplantation of HCV-positive individuals, especially among donors older than 60 years.
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    • "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. "
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