Contribution of donor age to the recent decrease in patient survival among HCV-infected liver transplant recipients.
Recurrent hepatitis occurs in the majority of patients undergoing liver transplantation for hepatitis C virus (HCV) cirrhosis, with progression to cirrhosis in up to 30% after 5 years. Based on these data, a decrease in survival can be anticipated with prolonged follow-up. Furthermore, posttransplantation HCV-fibrosis progression has been shown in recent years to increase. Our aims were (1) to describe the natural history of HCV-infected recipients, particularly to determine whether survival has decreased in recent years; (2) to compare this outcome with that observed in non-HCV-infected cirrhosis controls; and (3) to determine the factors associated with disease severity and survival. Among 522 cirrhotic patients undergoing transplantation between 1991 and 2000, 283 (54%) were infected with HCV. Yearly biopsies were performed in these recipients and at 1 and 5 years in the remainder. With similar follow-up, the percentage of deaths in the HCV(+) group was significantly higher than in the HCV- group (37% vs. 22%, P <.001), and patient survival was lower (77%, 61%, 55% vs. 87%, 76%, 70% at 1, 5, and 7 years, respectively; P =.0001). Although survival has increased in the HCV- group in recent years, it has significantly decreased in HCV recipients (P <.0001). The main cause of death among the latter was decompensated graft cirrhosis (n = 23/105, 22%), whereas that of HCV- patients was infections (n = 10/52, 19%). Reasons for the recent worse outcome in HCV+ recipients include the increased donor age and stronger immunosuppression. In conclusion, patient survival is lower among HCV+ recipients than among HCV- ones and has been decreasing in recent years. The aging of donors is a major contributor to this worse outcome.
Berenguer
Marina
M
HepatoGastroenterology Service, Hospital Universitario La Fe, Avenida Campanar 21, 46009 Valencia, Spain. mbhaym@teleline.es
Prieto
Martín
M
San Juan
Fernando
F
Rayón
José M
JM
Martinez
Fernando
F
Carrasco
Domingo
D
Moya
Angel
A
Orbis
Francisco
F
Mir
José
J
Berenguer
Joaquín
J
D000328:Adult; D000367:Age Factors; D000368:Aged; D001706:Biopsy; D005260:Female; D006085:Graft Survival; D006526:Hepatitis C / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000401:mortality / Q000601:surgery / Q000821:virology; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012307:Risk Factors; D015996:Survival Rate; D014019:Tissue Donors; D016896:Treatment Outcome