title: The difference in the fibrosis progression of recurrent hepatitis C after live donor liver transplantation versus deceased donor liver transplantation is attributable to the difference in donor age.
abstract: Hepatitis C recurs universally after liver transplantation (LT). Whether its progression differs after live donor liver transplantation (LDLT) and deceased donor liver transplantation (DDLT) is still debated. We retrospectively analyzed 201 consecutive LTs performed at our institution for hepatitis C-related end-stage liver disease between April 2000 and December 2005 (46 LDLTs and 155 DDLTs). Patients were followed with protocol biopsies for medians of 29 (LDLT) and 39 months (DDLT; P = 0.7). Although overall graft and patient survival did not differ, the mean fibrosis stage (Metavir) was significantly higher at 12 to 48 months post-LT (all P < 0.05), and the rate of fibrosis progression tended to be faster after DDLT than LDLT (0.19 versus 0.11 stage/year, P = 0.05). In univariate analysis, donor age, cold ischemic time, and DDLT were significantly associated with a fibrosis stage > or = 1 at 1 year and a fibrosis stage of 3 or 4 at 2 years post-LT. In multivariate analysis, however, donor age was the sole variable independently associated with both surrogate outcomes. Thus, donor age > 45 years carried a relative risk of 8.17 (confidence interval = 2.6-25.5, P = 0.001) for reaching fibrosis stage 3 or 4 at 2 years post-LT. In conclusion, donor age, rather than the transplant approach, determines the progression of recurrent hepatitis C after LT. LDLT, allowing for the selection of younger donors, may particularly benefit hepatitis C patients.
authors.affiliation: Multi-Organ Transplant Program, University Health Network, University of Toronto, Toronto, Canada.
authors.forename: Nazia
authors.initials: N
authors.lastname: Selzner
authors.forename: Nigel
authors.initials: N
authors.lastname: Girgrah
authors.forename: Les
authors.initials: L
authors.lastname: Lilly
authors.forename: Maha
authors.initials: M
authors.lastname: Guindi
authors.forename: Markus
authors.initials: M
authors.lastname: Selzner
authors.forename: George
authors.initials: G
authors.lastname: Therapondos
authors.forename: Oyedele
authors.initials: O
authors.lastname: Adeyi
authors.forename: Ian
authors.initials: I
authors.lastname: McGilvray
authors.forename: Mark
authors.initials: M
authors.lastname: Cattral
authors.forename: Paul D
authors.initials: PD
authors.lastname: Greig
authors.forename: David
authors.initials: D
authors.lastname: Grant
authors.forename: Gary
authors.initials: G
authors.lastname: Levy
authors.forename: Eberhard L
authors.initials: EL
authors.lastname: Renner
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002102:Cadaver; D018450:Disease Progression; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008103:Liver Cirrhosis / Q000473:pathology* / Q000601:surgery / Q000821:virology; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D014019:Tissue Donors