22 Jul 2008
Medical News Today
Patients with the hepatitis C virus who receive a liver from a donor older than age 60 do not experience a higher rate of transplant failure, death, or recurrent disease in the following five years, according to a study published in the July issue of
Archives of Surgery.
The most common reason for liver transplants among adults in the United States is cirrhosis of the liver caused by the hepatitis C viral infection. Though hospitals have been expanding requirements for donors to increase the number of eligible organs, about 17,000 patients remain on the waiting list for a liver transplant. One criteria change has been increasing donor age limits. "There are concerning reports, however, in recipients with hepatitis C virus that extended criteria donors, particularly older donors, are associated with poorer outcome, especially with early and severe hepatitis C virus recurrence in the donor graft," note the authors.
To analyze the outcomes of liver transplants from donors of various ages, M.B. Majella Doyle, M.D. (Washington University School of Medicine, St. Louis) and colleagues used data from 489 adult liver transplants performed between 1997 and 2006. Some of the patients needed a liver transplant due to hepatitis C (187 of 489 or 38.2%), while others presented a different indication for transplant (302 of 489 or 61.8%).
Survival rates for patients with the hepatitis C virus were: 88.1% after one year, 78.3% after three years, and 69.2% after five years. In this group of hepatitis C virus-positive recipients, 85.6% of donor livers were still functioning after one year, 75.6% after three years, and 65.6% after five years. Among patients with and without hepatitis C, the researchers did not find significant differences in rates of survival and graft survival at one, three, or five years. The authors caution, however, that, "Similar to other long-term transplant centers, we observed a negative effect from recurrent hepatitis C virus with a trend toward worsened long-term survival between years five and 10."
Livers from donors who were age 60 and older were transplanted into 72 patients - 24 (12.8%) with hepatitis C virus and 48 (15.9%) without the virus. Patient and graft survival rates at one, three, and five years for patients who received livers from donors age 60 and older were not significantly different than survival rates for patients who received organs from younger donors. The researchers also found no difference in survival rates if the donor was age 65 or older. These results suggest that the practice of using livers from older donors is safe, according to the authors.
The researchers conclude that, "Overall patient and graft survival in hepatitis C virus-positive recipients is comparable with that in hepatitis C virus-negative patients, and there seems to be little, if any, adverse effect on short- and medium-term follow-up with the use of carefully selected older donor grafts in recipients with hepatitis C virus...Data from this series suggest that the continued use of selected older donors is a safe method of expanding the liver donor pool, even for hepatitis C-positive recipients."
Written by: Peter M Crosta
Copyright: Medical News Today Abstract - Liver Transplant for Hepatitis C Virus
Effect of Using Older Donor Grafts on Short- and Medium-Term Survival
M. B. Majella Doyle, MD; Christopher D. Anderson, MD; Neeta Vachharajani, MD; Jeffrey A. Lowell, MD; Surendra Shenoy, MD; Mauricio Lisker-Melman, MD; Kevin Korenblat, MD; Jeffrey S. Crippin, MD; William C. Chapman, MD
Arch Surg. 2008;143:679-685.
Hypothesis Older donor grafts will provide suitable resultsof liver transplant, even in recipients with hepatitis C virus(HCV). Although HCV remains the leading indication for livertransplant in adults in the United States, it is associatedwith HCV recurrence, increased graft loss, and reduced survival.In addition, recent studies suggest that the use of older donorsin recipients with HCV is associated with significantly worsenedshort- and long-term survival.
Design Prospective database analysis.
Setting Washington University School of Medicine.
Patients Between January 1, 1997, and June 30, 2006, atotal of 579 liver transplants were performed. Ninety pediatrictransplants were excluded. Of the remaining 489 adult patients(84.5%), 187 (38.2%) had HCV and 302 (61.8%) had other indications.
Main Outcome Measures Patient and graft survival, recurrenceof HCV, and need for and results of retransplant.
Results At 1, 3, and 5 years, overall patient survivalwas 88.1%, 78.3%, and 69.2%, respectively, and graft survivalwas 85.6%, 75.6%, and 65.6%, respectively, in patients withHCV. There was no significant difference in patient or graftsurvival between patients with and those without HCV. RecurrentHCV with clinically significant disease was 20% at 1 year and62% at 10 years. Seventy-two patients received transplants fromdonors 60 years or older (24 of 187 [12.8%] with HCV and 48of 302 [15.9%] without HCV). No difference was demonstratedin short- or medium-term patient or graft survival in recipientsof grafts from older donors.
Conclusion The increasing use of marginal donors, includingcarefully selected older donors, does not seem to adverselyaffect short- or medium-term results and may be a source ofadditional organs for expanding liver transplant waiting lists.
Author Affiliations: Section of Abdominal Transplantation, Department of Surgery (Drs Doyle, Anderson, Vachharajani, Lowell, Shenoy, and Chapman), and Division of Gastroenterology, Department of Medicine (Drs Lisker-Melman, Korenblat, and Crippin), Washington University School of Medicine, St Louis, Missouri.
