title: Risk of advanced fibrosis with grafts from hepatitis C antibody-positive donors: a multicenter cohort study.
abstract: Over the last decade, the use of liver grafts from hepatitis C virus antibody-positive donors [HCV(+)Ds] has tripled in the United States. Although previous studies have demonstrated no association between an HCV(+)D status and graft loss, the effects of an HCV(+)D on histological outcomes are not well known. Hepatitis C virus (HCV)-infected recipients at 5 US centers (2002-2007) who survived more than 30 days with 1 or more posttransplant biopsy samples were included. Cox regression was used to examine the association between an HCV(+)D status and advanced fibrosis (stage 3/4 or higher). Ninety-nine of the 1206 patients (8%) received an HCV(+)D graft. Recipients of HCV(+)D grafts were older than recipients of hepatitis C virus antibody-negative donor [HCV(-)D] grafts (P = 0.03), but they were otherwise similar. HCV(+)D grafts were significantly lower in quality according to the donor risk index (P < 0.001). Advanced fibrosis occurred in 32% of HCV(+)D graft recipients and in 28% of HCV(-)D graft recipients (P = 0.39). The unadjusted 1- and 3-year rates of advanced fibrosis were significantly higher for HCV(+)D graft recipients (14% and 48%) versus HCV(-)D graft recipients (7% and 33%, P = 0.01). Transplantation with HCV(+)D grafts was associated with a 58% increased risk of advanced fibrosis [95% confidence interval (CI) = 1.05-2.36, P = 0.03]. However, in an analysis stratified by the mean donor age of 45 years, an HCV(+)D status was associated with advanced fibrosis only with donors >45 years old [hazard ratio (HR) = 1.76, 95% CI = 1.06-2.93, P = 0.03] and not with donors ≤45 years old (HR = 0.94, 95% CI = 0.47-1.87, P = 0.85). In conclusion, a careful consideration of the risks and benefits is needed with HCV(+)D grafts. Recipients of HCV(+)D grafts (especially from older donors) should undergo close monitoring for more rapidly progressive fibrosis. Studies are needed to determine whether early HCV therapy modifies this risk.
authors.affiliation: Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, CA 94143, USA.
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Lai
authors.forename: Jacqueline G
authors.initials: JG
authors.lastname: O'Leary
authors.forename: James F
authors.initials: JF
authors.lastname: Trotter
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Verna
authors.forename: Robert S
authors.initials: RS
authors.lastname: Brown
authors.forename: R Todd
authors.initials: RT
authors.lastname: Stravitz
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Duman
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Forman
authors.forename: Norah A
authors.initials: NA
authors.lastname: Terrault
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006085:Graft Survival; D018937:Hepatitis C Antibodies / Q000097:blood*; D006801:Humans; D008103:Liver Cirrhosis / Q000209:etiology*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012306:Risk; D014019:Tissue Donors
chemical_list: D018937:Hepatitis C Antibodies