title: Increased risk of severe recurrence of hepatitis C virus in liver transplant recipients of donation after cardiac death allografts.
abstract: BACKGROUND
  In hepatitis C virus (HCV) recipients of donation after cardiac death (DCD) grafts, there is suggestion of lower rates of graft survival, indicating that DCD grafts themselves may represent a significant risk factor for severe recurrence of HCV.
  
  
  METHODS
  We evaluated all DCD liver transplant recipients from August 2006 to February 2011 at our center. Recipients with HCV who received a DCD graft (group 1, HCV+ DCD, n=17) were compared with non-HCV recipients transplanted with a DCD graft (group 2, HCV- DCD, n=15), and with a matched group of HCV recipients transplanted with a donation after brain death (DBD) graft (group 3, HCV+ DBD, n=42).
  
  
  RESULTS
  A trend of poorer graft survival was seen in HCV+ patients who underwent a DCD transplant (group 1) compared with HCV- patients who underwent a DCD transplant (group 2) (P=0.14). Importantly, a statistically significant difference in graft survival was seen in HCV+ patients undergoing DCD transplant (group 1) (73%) as compared with DBD transplant (group 3) (93%)(P=0.01). There was a statistically significant increase in HCV recurrence at 3 months (76% vs. 16%) (P=0.005) and severe HCV recurrence within the first year (47% vs. 10%) in the DCD group (P=0.004).
  
  
  CONCLUSIONS
  HCV recurrence is more severe and progresses more rapidly in HCV+ recipients who receive grafts from DCD compared with those who receive grafts from DBD. DCD liver transplantation in HCV+ recipients is associated with a higher rate of graft failure compared with those who receive grafts from DBD. Caution must be taken when using DCD grafts in HCV+ recipients.
authors.affiliation: Multi-Organ Transplant Program, London Health Sciences Centre, University Hospital, London, ON, Canada. roberto.hernandezalejandro@lhsc.on.ca
authors.forename: Roberto
authors.initials: R
authors.lastname: Hernandez-Alejandro
authors.forename: Kris P
authors.initials: KP
authors.lastname: Croome
authors.forename: Douglas
authors.initials: D
authors.lastname: Quan
authors.forename: Mohamed
authors.initials: M
authors.lastname: Mawardi
authors.forename: Natasha
authors.initials: N
authors.lastname: Chandok
authors.forename: Cheryl
authors.initials: C
authors.lastname: Dale
authors.forename: Vivian
authors.initials: V
authors.lastname: McAlister
authors.forename: Mark A
authors.initials: MA
authors.lastname: Levstik
authors.forename: William
authors.initials: W
authors.lastname: Wall
authors.forename: Paul
authors.initials: P
authors.lastname: Marotta
mesh_terms: D000328:Adult; D001926:Brain Death; D003643:Death; D005260:Female; D006085:Graft Survival; D016174:Hepacivirus / Q000378:metabolism; D006526:Hepatitis C / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012306:Risk; D012307:Risk Factors; D014184:Transplantation, Homologous