title: Hepatitis C disease severity in living versus deceased donor liver transplant recipients: an extended observation study.
abstract: Donor factors influence hepatitis C virus (HCV) disease severity in liver transplant (LT) recipients. Living donors, because they are typically young and have short cold ischemic times, may be advantageous for HCV-infected patients. Among HCV-infected patients in the Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL) surviving >90 days and followed for a median 4.7 years, advanced fibrosis (Ishak stage ≥3) and graft loss were determined. The 5-year cumulative risk of advanced fibrosis was 44% and 37% in living donor LT (LDLT) and deceased donor LT (DDLT) patients (P = 0.16), respectively. Aspartate aminotransferase (AST) activity at LT (hazard ratio [HR] = 1.38 for doubling of AST, P = 0.005) and biliary strictures (HR = 2.68, P = 0.0001) were associated with advanced fibrosis, but LDLT was not (HR = 1.11, 95% confidence interval [CI] 0.73-1.69, P = 0.63). The 5-year unadjusted patient and graft survival probabilities were 79% and 78% in LDLT, and 77% and 75% in DDLT (P = 0.43 and 0.32), with 27% and 20% of LDLT and DDLT graft losses due to HCV (P = 0.45). Biliary strictures (HR = 2.25, P = 0.0006), creatinine at LT (HR = 1.74 for doubling of creatinine, P = 0.0004), and AST at LT (HR = 1.36 for doubling of AST, P = 0.004) were associated with graft loss, but LDLT was not (HR = 0.76, 95% CI: 0.49-1.18, P = 0.23).
  
  
  CONCLUSIONS
  Donor type does not affect the probability of advanced fibrosis or patient and graft survival in HCV-infected recipients. Thus, while LDLT offers the advantage of shorter wait times, there is no apparent benefit for HCV disease progression. Biliary strictures have a negative effect on HCV fibrosis severity and graft survival, and a high AST at LT may be an important predictor of fibrosis risk post-LT.
authors.affiliation: University of California, San Francisco, San Francisco, CA.
authors.forename: Norah A
authors.initials: NA
authors.lastname: Terrault
authors.forename: R Todd
authors.initials: RT
authors.lastname: Stravitz
authors.forename: Anna S F
authors.initials: AS
authors.lastname: Lok
authors.forename: Greg T
authors.initials: GT
authors.lastname: Everson
authors.forename: Robert S
authors.initials: RS
authors.lastname: Brown
authors.forename: Laura M
authors.initials: LM
authors.lastname: Kulik
authors.forename: Kim M
authors.initials: KM
authors.lastname: Olthoff
authors.forename: Sammy
authors.initials: S
authors.lastname: Saab
authors.forename: Ovedele
authors.initials: O
authors.lastname: Adeyi
authors.forename: Curtis K
authors.initials: CK
authors.lastname: Argo
authors.forename: Jay E
authors.initials: JE
authors.lastname: Everhart
authors.forename: Del R
authors.initials: del R
authors.lastname: Rodrigo
mesh_terms: D000328:Adult; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology; D006526:Hepatitis C / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014019:Tissue Donors; D014180:Transplantation; D016896:Treatment Outcome