HCV POSITIVE GRAFTS IN LIVER TRANSPLANTATION: OUTCOME AND INTERACTION BETWEEN DONOR AND RECIPIENT VIRAL STRAIN

Abstract

O328 Aims: To evaluate if HCV-infected livers transplanted into HCV-infected recipients convey a worse outcome than HCV-negative grafts. Methods: We retrospectively analysed the outcome of 19 Liver Transplantations (LT) performed from july 1998 to december 2003 in HCV positive patients with livers from HCV positive donors. 428 patients with HCV cirrhosis who underwent LT in our center using livers from HCV negative donors were the control group.All HCV positive livers were submitted to heart-beating biopsy during retrieval to evaluate Ishak score. Other variables considered were: donor age, hepatic enzymes and ICU stay; total ischemia time; recipient age; HCV genotyping of donor and recipient (before LT and three months after LT). We considered outcome indexes patient and graft survival and hepatitis recurrence rate.Recurrent hepatitis was always biopsy-proven.Statistical analysis was performed using SPSS. Univariate survival was analysed by Kaplan-Meier method. Results: There were no significant differences between the two groups about donor age (median 59,7± 11,2 yrs in HCV+ donors vs 50,2±16,9 in control group), recipient age (53,7 ± 5,6 vs 51,7± 7,7), hepatic donor enzymes (median AST 75,9±78,4 vs 58,7±61,1, median ALT 38,7± 26 vs 47,8± 37,9), total ischemia time (median 688,9±192 min vs 585,4 ± 164,3 min), and ICU days (median 5,4 ± 5,1 vs 4,8 ± 4,2).The Ishak score grading was more than 2/18 in 3 cases, and only 1 graft presented a staging score more than 2/6.In only two cases we matched different HCV genotyping, and in these cases donor strain took over the recipient strain. In one patient donor genotyping 2a-2c took over recipient genotyping 1b; 9 months after LT we documented recurrent hepatitis, and antiviral therapy (interferon+ribavirin) cleared HCV. Sustained Virological Response (SVR) was confirmed 3 years after therapy discontinuation. In the second patient subtype 1b became the predominat strain over donor genotyping 4; a mild recurrent hepatitis (Ishak score 4/18,2/6) was documented 12 months after LT.In the group of HCV positive donor only one retransplantation was performed; portal hypertension developed two months after LT in the graft with Ishak score more than 2/6. Cumulative 1 year patient and graft survival rate didn’t significantly differ in the HCV negative donor group from HCV positive group (84% vs 80%, and 78% vs 73%, respectively). Hepatitis recurrence rate at one year was also similar in the two groups (70,3% vs 69,5%). Conclusions: Our study suggests that livers from HCV positive donors can safely be used in LT for HCV cirrhosis. Hepatic biopsy must always be performed before using such livers, because the outcome of LT seems to be influenced by histological features of donor liver. The takeover of one strain by another is possible, and it may really change the prognosis of the patient if the predominant strain is more sensitive to the antiviral therapy.