Older donor livers show early severe histological activity, fibrosis, and graft failure after liver transplantation for hepatitis C.
BACKGROUND
In hepatitis C virus (HCV)-positive liver transplant recipients, infection of the allograft and recurrent liver disease are important problems. Increased donor age has emerged as an important variable affecting patient and graft survival; however, specific age cutoffs and risk ratios for poor histologic outcomes and graft survival are not clear.


METHODS
A longitudinal database of all HCV-positive patients transplanted at our center during an 11-year period was used to identify 111 patients who received 124 liver transplants. Graft survival and histological endpoints (severe activity and fibrosis) of HCV infection in the allografts were compared as a function of donor age at transplantation.


RESULTS
By Kaplan-Meier analyses, older allografts showed earlier failure and decreased time to severe histological activity and fibrosis as compared with allografts from younger donors. By Cox proportional hazards analysis, older allografts were at greater risk for all severe histologic features and decreased graft survival as compared with younger allografts (P< or =0.02 for all outcomes). Analysis of donor age as a dichotomous variable showed that donors greater than 60 yr were at high risk for deleterious histologic outcomes and graft failure. An age cutoff of 60 yr showed a sensitivity of 94% and specificity of 67% for worse graft survival by receiver operating characteristics curve.


CONCLUSIONS
Advanced donor age is associated with more aggressive recurrent HCV and early allograft failure in HCV-positive liver transplant recipients. Consideration of donor age is important for decisions regarding patient selection, antiviral therapy, and organ allocation.
Rayhill
Stephen C
SC
Department of Surgery, Roy J. and Lucille A. Carver College of Medicine, University of Iowa and Veterans Administration Medical Center, Iowa City, IA, USA. rayhills@ohsu.edu
Wu
You Min
YM
Katz
Daniel A
DA
Voigt
Michael D
MD
Labrecque
Douglas R
DR
Kirby
Patricia A
PA
Mitros
Frank A
FA
Kalil
Roberto S
RS
Miller
Rachel A
RA
Stolpen
Alan H
AH
Schmidt
Warren N
WN
D000328:Adult; D000367:Age Factors; D018450:Disease Progression; D005260:Female; D006084:Graft Rejection / Q000209:etiology* / Q000473:pathology; D006526:Hepatitis C / Q000473:pathology / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000209:etiology* / Q000473:pathology; D016031:Liver Transplantation / Q000009:adverse effects* / Q000473:pathology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012008:Recurrence; D012307:Risk Factors; D014019:Tissue Donors; D016896:Treatment Outcome