Donor age affects fibrosis progression and graft survival after liver transplantation for hepatitis C.
BACKGROUND
The use of liver allografts from an older donor (OD) (age>50 years) is a widespread strategy to manage the disparity between supply and demand of organs for liver transplantation. This study determines the effect of OD allografts on fibrosis progression and graft survival after liver transplantation in patients with and without infection caused by hepatitis C virus (HCV).


METHODS
All patients undergoing liver transplantation at our center from March 1998 to December 2001 were analyzed. Protocol liver biopsies were performed at 1, 16, and 52 weeks after transplantation and yearly thereafter. One liver pathologist scored all biopsy specimens for modified hepatic activity index (0-18) and fibrosis (0-6).


RESULTS
A total of 402 patients (167 with HCV and 235 without HCV) underwent liver transplantation during the study period. Among patients with HCV, baseline characteristics of OD recipients were similar to younger donor (YD) (age<50 years) recipients. In patients with HCV, graft survival was shorter in OD graft recipients than in YD recipients (P<0.001). In patients without HCV, graft survival was independent of donor age. In patients with HCV, a fibrosis score of 3 or greater was present in 17% of OD recipients at 4 months and in 26% at 12 months after transplantation, compared with 8% of YD recipients at 4 months and 13% at 12 months (P<0.001).


CONCLUSIONS
Liver transplantation with OD grafts is associated with rapid progression of fibrosis and decreased graft survival in patients with HCV, but not in patients without HCV. OD grafts should be considered preferentially for patients without HCV.
Machicao
Victor I
VI
Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida 32216, USA.
Bonatti
Hugo
H
Krishna
Murli
M
Aqel
Bashar A
BA
Lukens
Frank J
FJ
Nguyen
Justin H
JH
Rosser
Barry G
BG
Satyanarayana
Raj
R
Grewal
Hani P
HP
Hewitt
Winston R
WR
Harnois
Denise M
DM
Crook
Julia E
JE
Steers
Jeffery L
JL
Dickson
Rolland C
RC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005355:Fibrosis; D006085:Graft Survival; D019698:Hepatitis C, Chronic / Q000601:surgery*; D006801:Humans; D008099:Liver / Q000473:pathology*; D016031:Liver Transplantation; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D016019:Survival Analysis; D014019:Tissue Donors