Hepatitis C Virus-Infected Donors in Liver Transplantation

Abstract

Preliminary findings suggest that hepatitis C virus (HCV)-infected liver transplant recipients receiving livers from HCV-infected donors may have a slower rate of fibrosis progression at 1 year. According to a case-control study presented May 20, 2007 at Digestive Disease Week 2007 in Washington, DC, a trend was seen in survival advantage for those receiving HCV-positive donor grafts compared with standard donor controls. “The use of HCV positive donors may be considered as a first line therapy to increase the available donor pool of organs in those undergoing orthoptic liver transplantation for HCV-related cirrhosis,” say researchers led by Paul Y. Kwo, Associate Professor of Medicine in the Division of Digestive Diseases at Indiana University School of Medicine in Indianapolis. This study utilized a case-control design to compare transplant outcomes for 38 recipients of livers from HCV-infected donors with those for 76 standard, nonextended criteria (ECD) donors (1 case/2 controls). Data were extracted from the transplant center registry, UNOS data, and the original on-site donor data chart. Thirty percent of all donors met non-ECD criteria (standard donors) and were included as potential matches for the case-control study. Each HCV-positive liver donor recipient was matched with 2 standard donor recipients as matched standard donor controls (MSDC) by (1) recipient age ± 10 years; (2) primary diagnosis; (3) cancer stage for those with hepatocellular carcinoma; (4) recipient Model for End-Stage Liver Disease score ± 5; and (5) donor age ± 10 years. Outcomes included graft and patient survival at 3 months, 1 year, and 2 years; perioperative death; and HCV recurrence by 4-month and 1-year fibrosis (F0–F4). The HCV donor and MSDC groups did not differ for recipient or donor demographics or in cold and warm ischemia times. Survival results and fibrosis progression are shown in Table 1. Median follow-up time was 36 months. Kaplan–Meier actuarial survival demonstrated improved graft survival for HCV-infected donors with a trend toward significance (P = .10).Tabled 1Hepatitis C-infected donorMatched standard donor controls (MSDC)n-value*TOTALn = 38n = 7690-day survival Graft37/38 (97.4%)72/76 (94.7%)NS Patient37/38 (97.4%)72/76 (94.7%)NS1-year survival Graft30/31 (96.8%)62/72 (86.1%)NS Patient31/31 (96.8%)63/72 (87.5%)NS2-year survival Graft16/19 (84.2%)49/62 (79.0%)NS Patient17/19 (84.2%)52/62 (83.9%)NSGraft loss within 7 days1/38 (2.6%)1/76 (1.3%)NSMean fibrosis at 4 months (F0–F4)0.680.330.08Mean fibrosis at 12 months (F0–F4).0861.05NSPercent change in fibrosis26%69% Open table in a new tab