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The outcome of liver grafts procured from hepatitis C-positive donors
Ergun Velidedeoglu1, Niraj M Desai, Louis Campos
1Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania 19104, USA.
Insights
Liver transplants using hepatitis C virus (HCV)+ donor grafts show similar survival in HCV+ recipients compared to HCV- grafts. However, recipient HCV positivity independently predicts poorer graft survival.
Area of Science:
- Hepatology
- Transplant Surgery
- Virology
Background:
- Increasing hepatitis C virus (HCV) prevalence leads to more HCV+ organ donors.
- Graft survival from HCV+ donors requires further investigation.
Purpose of the Study:
- To assess liver graft survival from HCV+ donors in HCV+ recipients.
- To identify factors influencing graft survival in liver transplantation.
Main Methods:
- Retrospective analysis of two cohorts: single institution (13 HCV+ vs. 103 HCV- grafts) and UNOS database (14,195 adult patients).
- Kaplan-Meier analysis for graft survival based on donor/recipient HCV status.
- Cox proportional hazards analysis to determine independent predictors of graft survival.
Main Results:
- No significant difference in graft survival between HCV+ and HCV- grafts in HCV+ recipients at the single institution.
- HCV+ grafts in HCV+ recipients showed equivalent survival to HCV- grafts in HCV+ recipients in UNOS data.
- Recipient HCV positivity, not donor status, was an independent predictor of inferior graft survival.
Conclusions:
- Liver allografts from HCV+ donors demonstrate comparable survival to HCV- grafts when transplanted into HCV+ recipients.
- Recipient HCV positivity is a significant independent predictor of graft failure in liver transplantation.
Background:
The growing prevalence of hepatitis C virus (HCV) infection in the general population has resulted in an increased frequency of potential organ donors that carry the virus. The survival of grafts from HCV+ donors has not been studied in detail.
Methods:
Two study populations were examined retrospectively to assess the survival of liver grafts procured from HCV+ donors. First, we evaluated the survival of all 13 HCV+ and 103 HCV- grafts that were transplanted at our institution to HCV+ recipients from January 1, 1995 to December 31, 1999. In parallel, we analyzed a subset of the United Network for Organ Sharing (UNOS) liver transplant database from the same 5-year time period that was comprised of 14,195 adult patients for whom donor and recipient HCV serologies were known. Kaplan-Meier graft survival for both patient populations was calculated based on donor and recipient HCV serologic status. A Cox proportional hazards analysis was performed on UNOS data to identify variables independently predicting graft survival.
Results:
For transplants performed at our institution, we found no statistically significant difference in the Kaplan-Meier graft survival of HCV+ and HCV- grafts transplanted to HCV+ recipients (P=0.68). The incidence of biopsy-proven, recurrent HCV posttransplant was similar in recipients receiving either HCV+ or HCV- grafts (4/13 vs. 18/103, chi-square P=0.211). Analysis of UNOS data revealed that the survival of HCV+ grafts in HCV+ recipients was equivalent to the survival of HCV- grafts in HCV+ recipients. Unexpectedly, the survival of grafts in HCV+ recipients in general was significantly inferior to that of grafts in HCV- recipients. Multivariate analysis of all patients found recipient but not donor HCV status to be independently predictive of graft survival.
Conclusions:
Analysis of data from a single center and the national UNOS database suggests that transplantation of liver allografts from HCV+ donors to HCV+ recipients results in graft survival comparable to HCV- grafts transplanted to HCV+ recipients. In contrast, recipient HCV positivity is an independent predictor of graft failure compared with patients transplanted for other causes of liver disease.