Liver transplant for hepatitis C virus: effect of using older donor grafts on short- and medium-term survival.
OBJECTIVE
Older donor grafts will provide suitable results of liver transplant, even in recipients with hepatitis C virus (HCV). Although HCV remains the leading indication for liver transplant in adults in the United States, it is associated with HCV recurrence, increased graft loss, and reduced survival. In addition, recent studies suggest that the use of older donors in recipients with HCV is associated with significantly worsened short- and long-term survival.


METHODS
Prospective database analysis.


METHODS
Washington University School of Medicine.


METHODS
Between January 1, 1997, and June 30, 2006, a total of 579 liver transplants were performed. Ninety pediatric transplants were excluded. Of the remaining 489 adult patients (84.5%), 187 (38.2%) had HCV and 302 (61.8%) had other indications.


METHODS
Patient and graft survival, recurrence of HCV, and need for and results of retransplant.


RESULTS
At 1, 3, and 5 years, overall patient survival was 88.1%, 78.3%, and 69.2%, respectively, and graft survival was 85.6%, 75.6%, and 65.6%, respectively, in patients with HCV. There was no significant difference in patient or graft survival between patients with and those without HCV. Recurrent HCV with clinically significant disease was 20% at 1 year and 62% at 10 years. Seventy-two patients received transplants from donors 60 years or older (24 of 187 [12.8%] with HCV and 48 of 302 [15.9%] without HCV). No difference was demonstrated in short- or medium-term patient or graft survival in recipients of grafts from older donors.


CONCLUSIONS
The increasing use of marginal donors, including carefully selected older donors, does not seem to adversely affect short- or medium-term results and may be a source of additional organs for expanding liver transplant waiting lists.
Doyle
M B Majella
MB
Department of Surgery, Section of Abdominal Transplantation, Washington University School of Medicine, St Louis, Missouri 63110, USA.
Anderson
Christopher D
CD
Vachharajani
Neeta
N
Lowell
Jeffrey A
JA
Shenoy
Surendra
S
Lisker-Melman
Mauricio
M
Korenblat
Kevin
K
Crippin
Jeffrey S
JS
Chapman
William C
WC
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D006085:Graft Survival; D016174:Hepacivirus; D006526:Hepatitis C / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012086:Reoperation; D016019:Survival Analysis; D013997:Time Factors; D014019:Tissue Donors; D019737:Transplants