title: Impact of donor age on survival and fibrosis progression in patients with hepatitis C undergoing liver transplantation using HCV+ allografts.
abstract: Studies have suggested that the use of hepatitis C virus (HCV)-positive (HCV+) donor allografts has no impact on survival. However, no studies have examined the effect that HCV+ donor histology has upon recipient and graft survival. We evaluated the clinical outcome and impact of histological features in HCV patients transplanted using HCV+ livers. We reviewed all patients transplanted for HCV at our institution from 1988 to 2004; 39 received HCV+ allografts and 580 received HCV-negative (HCV-) allografts. Survival curves compared graft and patient survival. Each HCV+ allograft was stringently matched to a control of HCV- graft recipients. No significant difference in survival was noted between recipients of HCV+ livers and controls. Patients receiving HCV+ allografts from older donors (age > or =50 yr) had higher rates of graft failure (hazard ratio, 2.74) and death rates (hazard ratio, 2.63) compared to HCV- allograft recipients receiving similarly-aged older donor livers. Matched case-control analysis revealed that recipients of HCV+ allografts had more severe fibrosis post-liver transplantation than recipients of HCV- livers (P = 0.008). More advanced fibrosis was observed in HCV+ grafts from older donors compared to HCV+ grafts from younger donors (P = 0.012). In conclusion, recipients of HCV+ grafts from older donors have higher rates of death and graft failure, and develop more extensive fibrosis than HCV- graft recipients from older donors. Recipients of HCV+ grafts, regardless of donor age, develop more advanced liver fibrosis than recipients of HCV- grafts.
authors.affiliation: Division of Liver Diseases, Department of Medicine, The Mount Sinai Medical Center, New York, NY 10029, USA. asma.khapra@jhu.edu
authors.forename: Asma Poonawala
authors.initials: AP
authors.lastname: Khapra
authors.forename: Kaushik
authors.initials: K
authors.lastname: Agarwal
authors.forename: Maria Isabel
authors.initials: MI
authors.lastname: Fiel
authors.forename: Nickolas
authors.initials: N
authors.lastname: Kontorinis
authors.forename: Sabera
authors.initials: S
authors.lastname: Hossain
authors.forename: Sukru
authors.initials: S
authors.lastname: Emre
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Schiano
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D019992:Databases as Topic; D018450:Disease Progression; D005260:Female; D005355:Fibrosis / Q000473:pathology; D006084:Graft Rejection; D006085:Graft Survival; D006526:Hepatitis C / Q000453:epidemiology*; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis; D014019:Tissue Donors; D014184:Transplantation, Homologous; D016896:Treatment Outcome