title: Improving graft survival for patients undergoing liver transplantation.
abstract: Liver transplant (LT) outcomes are reported to be improving in non-HCV recipients but not for those infected with HCV. Our aim was to evaluate graft survival and predictors of outcome in HCV and non-HCV patients before and after 2003. Patients with primary LT between February 1, 1998, and December 31, 2005, were included. Patients were divided into Era 1 (1998-2002) and Era 2 (2003-2005) with follow-up through May 31, 2009. Graft survival was compared for HCV, non-HCV, and all patients. There was significant improvement in graft survival in Era 2 for HCV patients. Graft survival in Era 2 of HCV patients was equivalent to non-HCV patients. The most significant improvement between eras was in outcomes of grafts from donors ≥60 yr with three-yr graft survival 58.6 (51.3-65.9) vs. 75.4 (68.9-81.9), p = 0.002. The use of donors ≥60 did not change between eras: 31% vs. 34%; however, utilization in HCV recipients decreased from 36% to 3% (p < 0.001). In conclusion, graft survival of HCV patients has improved significantly since 2003 and was comparable to non-HCV patients up to three yr. The change in management of donor organs into HCV and non-HCV patients likely contributed to this outcome.
authors.affiliation: Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA. Rolland.C.Dickson@Hitchcock.Org
authors.forename: Rolland C
authors.initials: RC
authors.lastname: Dickson
authors.forename: Surakit
authors.initials: S
authors.lastname: Pungpapong
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Keaveny
authors.forename: C Burcin
authors.initials: CB
authors.lastname: Taner
authors.forename: Marwan
authors.initials: M
authors.lastname: Ghabril
authors.forename: Jaime
authors.initials: J
authors.lastname: Aranda-Michel
authors.forename: Raj
authors.initials: R
authors.lastname: Satyanarayana
authors.forename: Hugo
authors.initials: H
authors.lastname: Bonatti
authors.forename: David J
authors.initials: DJ
authors.lastname: Kramer
authors.forename: Justin H
authors.initials: JH
authors.lastname: Nguyen
mesh_terms: D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000517:prevention & control*; D006085:Graft Survival; D016174:Hepacivirus; D006526:Hepatitis C / Q000601:surgery*; D006801:Humans; D008107:Liver Diseases / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D014019:Tissue Donors; D016896:Treatment Outcome