Liver transplantation for hepatitis C from donation after cardiac death donors: an analysis of OPTN/UNOS data.
Donation after cardiac death (DCD) liver transplantation is increasing largely because of a shortage of organs. However, there are almost no data that have specifically assessed the impact of using DCD livers for HCV patients. We retrospectively studied adult primary DCD liver transplantation (630 HCV, 1164 non-HCV) and 54 129 donation after brain death (DBD) liver transplantation between 2002 and 2009 using the UNOS/OPTN database. With donation after brain death (DBD) livers, HCV recipients had significantly inferior graft survival compared to non-HCV recipients (p < 0.0001). Contrary to DBD donors, DCD livers used in HCV patients showed no difference in graft survival compared to non-HCV patients (p = 0.5170). Cox models showed DCD livers and HCV disease had poorer graft survival (HR = 1.80 and 1.28, p < 0.0001, respectively). However, the hazard ratio of DCD and HCV interaction was 0.80 (p = 0.02) and these results suggest that DCD livers on HCV disease do not fare worse than DCD livers on non-HCV disease. The graft survival of recent years (2006-2009) was significantly better than that in former years (2002-2005) (p = 0.0482). In conclusion, DCD liver transplantation for HCV disease showed satisfactory outcomes. DCD liver transplantation can be valuable option for HCV related end-stage liver disease.
Division of Transplantation, Department of Surgery, Penn State University, College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA. tuemura@hmc.psu.edu
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Uemura
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Ramprasad
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Hollenbeak
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Bezinover
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Kadry
D000328:Adult; D001926:Brain Death; D002102:Cadaver; D016757:Death, Sudden, Cardiac; D005260:Female; D006085:Graft Survival; D016174:Hepacivirus / Q000472:pathogenicity; D006526:Hepatitis C / Q000401:mortality / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014019:Tissue Donors / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome