Immunosuppression and donor age with respect to severity of HCV recurrence after liver transplantation.
In HCV cirrhotic patients after liver transplantation, survival and recurrence of HCV appears to be worsening in recent years. Donor age has been suggested as a cause. However, it is not clear if early and/or late mortality is affected and whether donor age is a key factor, as opposed to changes in immunosuppression. The aim of this study was to assess impact of donor age and other factors with respect to the severity of HCV recurrence posttransplant. A consecutive series of 193 HCV cirrhotic patients were transplanted with cadaveric donors, median age 41.5 years (13-73) and median follow-up of 38 months (1-155). Donor age and other factors were examined in a univariate/multivariate model for early/late survival, as well as fibrosis (grade 4 or more, Ishak score) with regular biopsies, 370 in total, from 1 year onwards. Results of the study indicated that donor age influenced only short-term (3 months) survival, with no significant effect on survival after 3 months. Known HCC independently adversely affected survival, as did the absence of maintenance azathioprine. Severe fibrosis (stage > or = 4) in 51 patients was related to neither donor age nor year of transplantation, but it was independently associated with combined biochemical/histological hepatitis flare (OR 2.9, 95% CI 1.76-4.9) whereas maintenance steroids were protective (OR 0.4, 95% CI 0.23-0.83). In conclusion, in this cohort donor age did not influence late mortality in HCV transplanted cirrhotic patients or development of severe fibrosis, which was related to absence of maintenance steroids and a hepatitis flare. Maintenance azathioprine gave survival advantage.
Samonakis
Dimitrios N
DN
Royal Free Hospital, Liver Transplantation and Hepatobiliary Unit, London, UK.
Triantos
Christos K
CK
Thalheimer
Ulrich
U
Quaglia
Alberto
A
Leandro
Gioacchino
G
Teixeira
Rosângela
R
Papatheodoridis
George V
GV
Sabin
Caroline A
CA
Rolando
Nancy
N
Davies
Susan
S
Dhillon
Amar P
AP
Griffiths
Paul
P
Emery
Vincent
V
Patch
David W
DW
Davidson
Brian R
BR
Rolles
Keith
K
Burroughs
Andrew K
AK
D000328:Adult; D000367:Age Factors; D000368:Aged; D001379:Azathioprine / Q000627:therapeutic use; D016572:Cyclosporine / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006085:Graft Survival; D006526:Hepatitis C / Q000401:mortality* / Q000601:surgery; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008103:Liver Cirrhosis / Q000601:surgery / Q000821:virology; D016031:Liver Transplantation / Q000276:immunology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives*; D011239:Prednisolone / Q000008:administration & dosage; D012008:Recurrence; D016559:Tacrolimus / Q000008:administration & dosage
D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D011239:Prednisolone; D009173:Mycophenolic Acid; D001379:Azathioprine; D016559:Tacrolimus