Contribution of donor age to the recent decrease in patient survival among HCV-infected liver transplant recipients

Area of Science:

• Hepatology
• Transplantation immunology
• Viral hepatitis

Background:

• Recurrent hepatitis C virus (HCV) infection post-liver transplant is common, leading to graft cirrhosis in up to 30% within 5 years.
• Progression of fibrosis after transplantation has notably increased in recent years.
• Anticipated decreased survival with prolonged follow-up necessitates investigation into recent trends.

Purpose of the Study:

• To describe the natural history of HCV-infected liver transplant recipients.
• To determine if survival rates have declined in recent years for HCV-positive recipients.
• To compare outcomes with non-HCV-infected cirrhosis controls and identify factors influencing disease severity and survival.

Main Methods:

• Retrospective analysis of 522 cirrhotic patients undergoing liver transplantation between 1991 and 2000.
• Categorization into HCV-infected (n=283) and HCV-negative groups.
• Biopsies performed yearly for HCV recipients and at 1 and 5 years for controls; survival data analyzed.

Main Results:

• HCV-positive recipients had significantly higher mortality (37% vs. 22%) and lower patient survival (55% at 7 years) compared to HCV-negative recipients (70% at 7 years).
• While survival improved in HCV-negative recipients, it significantly decreased in HCV-positive recipients in recent years.
• Leading causes of death were decompensated graft cirrhosis in HCV+ and infections in HCV- patients. Increased donor age and stronger immunosuppression were identified as reasons for worse outcomes in HCV+ recipients.

Conclusions:

• Patient survival is lower in HCV-positive liver transplant recipients compared to HCV-negative recipients.
• Survival rates for HCV-positive recipients have been decreasing in recent years.
• Aging donor organs represent a significant contributing factor to the poorer outcomes observed in HCV-positive liver transplant recipients.