The difference in the fibrosis progression of recurrent hepatitis C after live donor liver transplantation versus deceased donor liver transplantation is attributable to the difference in donor age (original) (raw)
Related papers
Advanced donor age increases the risk of severe recurrent hepatitis C after liver transplantation
Transplant International, 2005
The association between donor age and the severity of recurrent hepatitis C and, whether there is any donor age above which severity of recurrence increases significantly, were analyzed. A total of 131 liver grafts of hepatitis C virus (HCV)-infected recipients were selected for the study. Distribution of donor age was compared between grafts with and without severe recurrence. The risk of developing severe recurrence as well as the hepatitis-free, severe hepatitis-free and HCV-related graft survival was compared between different donor age groups. Mean donor age was higher for grafts with severe recurrence (P = 0.007). The risk of developing severe recurrence within 2 years post-transplant increased with donors aged ≥50 years (RR = 1.34) and donors aged ≥70 years (RR = 1.61). Five-year severe hepatitis-free survival rates decreased progressively when donor age was over 50 years (P < 0.001). The study shows 50 and 70 years as the donor age cut-off points above which the evolution of HCV-infected recipients worsens.
Transplantation, 2011
Background. Hepatitis C virus (HCV) recurrence is universal after liver transplantation (LT). Whether the progression of recurrent HCV is faster after live-donor LT (LDLT) compared with deceased-donor LT (DDLT) is debatable. Methods and Results. We retrospectively examined 100 consecutive LTs (65 DDLTs and 35 LDLTs) performed between July 2000 and July 2003. A total of 147 liver biopsies were performed between 6 months post-LT and last follow-up. Mean donor age and model for end-stage liver disease (MELD) score were significantly lower in LDLT (PϽ0.01). On a mean follow-up of 86.6Ϯ6.8 months, overall patient and graft survivals were 61% (51% DDLT vs. 77.1% LDLT; Pϭ0.026) and 56% (46.2% DDLT vs. 71.4% LDLT; Pϭ0.042), respectively. Eight of 39 (20.5%) deaths (7 DDLT and 1 LDLT) and two of nine (22.2%) retransplants (one in each group) were related to recurrent HCV. Mean fibrosis scores for DDLT and LDLT were 1.9Ϯ1.7 and 1.6Ϯ1.4, respectively (Pϭ0.01). When donor age less than 50 years and MELD score less than 25 were matched among 64 patients (32 DDLT and 32 LDLT), the overall patient and graft survivals were 73.4% (68.8% DDLT vs. 78.1% LDLT; Pϭ0.439) and 71.9% (71.9% DDLT vs. 71.9% LDLT; Pϭ0.978), respectively. Conclusions. Long-term survival rates were better, and fibrosis scores were lower for LDLT. The survivals between LDLT and DDLT were comparable for patients with MELD score less than 25 and donor age less than 50 years.
Liver Transplantation, 2009
We studied the role of donor and recipient age in transplantation/ischemia-reperfusion injury (TIRI) and short-and long-term graft and patient survival. Eight hundred twenty-two patients underwent deceased donor liver transplantation, with 197 donors being Ն60 years old. We evaluated markers of reperfusion injury, graft function, and clinical outcomes as well as short-and long-term graft and patient survival. Increased donor age was associated with more severe TIRI and decreased 3-and 5-year graft survival (73% versus 85% and 72% versus 81%, P Ͻ 0.001) and patient survival (77% versus 88% and 77% versus 82%, P Ͻ 0.003). Hepatitis C virus (HCV) infection and recipient age were the only independent risk factors for graft and patient survival in patients receiving an older graft. In the HCV(ϩ) cohort (297 patients), patients Ն 50 years old who were transplanted with an older graft versus a younger graft had significantly decreased 3-and 5-year graft survival (68% versus 83% and 64% versus 83%, P Ͻ 0.009). In contrast, HCV(ϩ) patients Ͻ 50 years old had similar 3-and 5-year graft survival if transplanted with either a young graft or an old graft (81% versus 82% and 81% versus 82%, P ϭ 0.9). In conclusion, recipient age and HCV status affect the graft and patient survival of older livers. Combining older grafts with older recipients should be avoided, particularly in HCV(ϩ) patients, whereas the effects of donor age can be minimized in younger recipients. Liver Transpl 15: 1288-1295, 2009.
American Journal of Transplantation, 2004
Studies suggest donor age and year of transplantation are associated with low graft survival in liver transplant recipients with hepatitis C. We sought to determine if advanced donor age and recent year of transplantation are associated with graft survival in hepatitis C recipients and to determine if the effect of donor age on graft survival is specific to hepatitis C. We analyzed the United Network for Organ Sharing liver transplant database from 1994 to 2002. Six thousand four hundred and four subjects transplanted for end-stage liver disease from chronic hepatitis C met our criteria. One-year graft survival in hepatitis C recipients with organs from donors <40 years old and ≥60 years old was 84% and 73%, p = = 0.003, respectively. These rates in recipients with cholestatic liver disease and alcoholic liver disease were 85% and 82%, respectively, p = = 0.11 and 82% and 78%, respectively, p = = 0.14. Three-year graft survival in hepatitis C recipients transplanted from 1994 to 1995 and 1996 to 1999 was 67% and 69%, respectively, p = = 0.10. Graft survival in hepatitis C recipients has not declined in recent years. Older donor age is associated with lower short-term graft survival in recipients with hepatitis C, but not in recipients with cholestatic or alcoholic liver disease.
Transplantation Proceedings, 2005
Introduction. Older donor allografts are being accepted for liver transplantation (LTx) due to shortage of organs. Hepatitis C virus (HCV) infection-related disease is presently the most common indication of LT in the United States. We studied the impact of donor age on patient and graft survivals in patients with HCV infection. Patients and methods. One hundred fifty four consecutive HCV(ϩ) LTx recipients (117 men, 37 women) were studied. The mean follow-up period was 41.0 Ϯ 30.2 months. The population was divided into four groups according to donor age: group I (Յ20 years); group II (21 to 40 years); group III (41 to 60 years); group IV (Ͼ60 years). Results. Thirty-two (20.8%) patients died during follow-up and 16 patients (10.4%) required retransplantation. The actuarial 7-year patient survivals for groups I, II, III, and IV were 87.1%, 73.7%, 69.3%, and 68.5%, respectively (P ϭ .4). Patient survivals for donor age groups III ϩ IV (n ϭ 95) and groups I ϩ II (n ϭ 59) were 68.9% and 77.2%, respectively (P ϭ .19). The 7-year graft survivals for groups I, II, III, and IV were 82.7%, 71.8%, 65.8%, and 62.5%, respectively (P ϭ .17). Graft survivals for groups III ϩ IV and groups I ϩ II were 58.4% and 76.2%, respectively (P ϭ .03). Conclusion. Patient and graft survivals for HCV-positive liver transplant recipients in this study decreased progressively as the donor age increased. Patient and graft survivals were best for group I recipients. There were significant differences in graft survivals when recipients were grouped with a cutoff donor age of 40 years.
Transplantation Proceedings, 2007
Introduction. Controversy exists as to whether there is an increased severity or frequency of recurrent hepatitis C viral (HCV) infection in recipients of adult living donor liver transplantation (LDLT) grafts. We sought to examine the time to histological recurrence and survival in HCV (ϩ) patients who underwent split liver transplantation (SLT), which is technically similar to what occurs in the LDLT procedure. Methods. Twenty four HCV (ϩ) adult recipients were identified through the UNOS database as having had SLT procedures at three centers: Mount Sinai Medical Center, University of Chicago, and University of California at Los Angeles. Of these, 17 patients with comprehensive data were matched to 32 HCV (ϩ) patients who underwent whole deceased donor liver transplantation (DDLT) during the same time period. Outcome and time to initial HCV recurrence as documented by liver biopsy were assessed. Liver biopsy was performed when clinically indicated. Results. Patients who had SLT were significantly older (P ϭ .01). There was no difference in number of rejection episodes (P ϭ .40). Fifteen of 17 SLT (88%) versus 24/32 DDLT (75%) patients had documented HCV recurrence by biopsy (P ϭ .46). The time to median cumulative incidence of recurrence of HCV post-liver transplantation was 12.6 months (SLT) versus 39.8 months (DDLT) patients. There was no difference in survival between SLT and DDLT patients (47 vs 70 months, P ϭ .62) nor in cumulative incidence of histological HCV recurrence at 1, 2, and 3 years (P ϭ .198, .919, and .806, respectively). Conclusion. There is no difference in the cumulative incidence of histological recurrence of HCV post-liver transplant or in survival between recipients of deceased donor and split liver transplants.
Liver Transplantation, 2007
In this retrospective study of hepatitis C virus (HCV)-infected transplant recipients in the 9-center Adult to Adult Living Donor Liver Transplantation Cohort Study, graft and patient survival and the development of advanced fibrosis were compared among 181 living donor liver transplant (LDLT) recipients and 94 deceased donor liver transplant (DDLT) recipients. Overall 3-year graft and patient survival were 68% and 74% in LDLT, and 80% and 82% in DDLT, respectively. Graft survival, but not patient survival, was significantly lower for LDLT compared to DDLT (P ϭ 0.04 and P ϭ 0.20, respectively). Further analyses demonstrated lower graft and patient survival among the first 20 LDLT cases at each center (LDLT 20) compared to later cases (LDLT Ͼ 20; P ϭ 0.002 and P ϭ 0.002, respectively) and DDLT recipients (P Ͻ 0.001 and P ϭ 0.008, respectively). Graft and patient survival in LDLT Ͼ20 and DDLT were not significantly different (P ϭ 0.66 and P ϭ 0.74, respectively). Overall, 3-year graft survival for DDLT, LDLT Ͼ20, and LDLT 20 were 80%, 79% and 55%, with similar results conditional on survival to 90 days (84%, 87% and 68%, respectively). Predictors of graft loss beyond 90 days included LDLT 20 vs. DDLT (hazard ratio [HR] ϭ 2.1, P ϭ 0.04), pretransplant hepatocellular carcinoma (HCC) (HR ϭ 2.21, P ϭ 0.03) and model for end-stage liver disease (MELD) at transplantation (HR ϭ 1.24, P ϭ 0.04). In conclusion, 3-year graft and patient survival in HCV-infected recipients of DDLT and LDLT Ͼ20 were not significantly different. Important predictors of graft loss in HCV-infected patients were limited LDLT experience, pretransplant HCC, and higher MELD at transplantation. Liver Transpl 13:122-129, 2007.
Hepatitis C recurrence is more severe after living donor compared to cadaveric liver transplantation
Hepatology, 2004
Preliminary reports suggested that hepatitis C virus (HCV) infection has a more aggressive course following living donor liver transplantation (LDLT) compared to cadaveric liver transplantation (CLT). The aim of this prospective study was to establish if HCV disease recurrence differs between LDLT and CLT. A cohort of 116 consecutive HCV-infected patients undergoing 117 LTs in a single center from March 2000 to August 2003 were followed-up, including systematic liver biopsies. Severe recurrence (SR) was defined as biopsy-proven cirrhosis and/or the occurrence of clinical decompensation. After a median follow-up of 22 months (2.6-44 months), 26 (22%) patients developed SR (decompensation in 12), involving 17 (18%) of 95 patients undergoing CLT and 9 (41%) of 22 undergoing LDLT. The 2-year probability of presenting SR was significantly higher in LDLT compared to CLT (45% vs. 22%, P ؍ .019). By univariate analysis LDLT (P ؍ .019) and an ALT higher than 80 IU/L 3 months after LT (P ؍ .022) were predictors of SR. In 93 patients from whom a liver biopsy was available 3 months after LT, a lobular necroinflammatory score >1 (P < .01), LDLT (P < .01), and biliary complications (P ؍ .046) were associated with SR. However, the only variables independently associated with SR were LDLT (odds ratio [OR], ؍ 2.8; 95% CI,1.19-6.6; P ؍ .024) and a lobular necroinflammatory score >1 (OR, 3.1; 95% CI, 1.2-8; P ؍ .013). In conclusion, HCV recurrence is more severe in LDLT compared to CLT. Although our results were based on a single-center experience, they should be considered in the decision-making process of transplant programs, since severe HCV recurrence may ultimately compromise graft and patient survival. (HEPATOLOGY 2004;