Liver transplantation from old donors into HCV and non-HCV recipients

Area of Science:

• Hepatology
• Transplantation Surgery
• Virology

Background:

• Chronic liver failure from Hepatitis C Virus (HCV)-related cirrhosis is a primary driver for liver transplantation in Western nations.
• Liver transplantation outcomes in HCV patients are often inferior, particularly when utilizing marginal donor organs.
• Elderly donors represent a growing, yet potentially marginal, donor pool.

Purpose of the Study:

• To retrospectively evaluate the impact of elderly donor age (>65 years) on liver transplantation outcomes in HCV-positive versus non-HCV recipients.
• To compare patient and graft survival rates between HCV-positive and non-HCV recipients of elderly donor livers.
• To identify potential risk factors associated with using elderly donor grafts in liver transplantation.

Main Methods:

• A retrospective analysis of 179 patients undergoing 204 liver transplantations.
• Patients were stratified into four groups based on HCV status and donor age (65 years).
• Kaplan-Meier method was employed to calculate long-term patient and graft survival rates.

Main Results:

• Liver grafts from donors >65 years into HCV-positive recipients demonstrated significantly lower patient and graft survival rates (40% vs 78% and 40% vs 68%, respectively) compared to those from younger donors.
• HCV-positive recipients of elderly donor grafts had poorer outcomes than non-HCV recipients, despite higher rates of macrosteatosis in organs used for non-HCV cases (55% vs 9%).
• The study noted a trend towards lower graft survival (P=.06) in HCV-positive recipients of older donor livers.

Conclusions:

• Liver transplantation using donor grafts from individuals >65 years of age is associated with worse outcomes in HCV-positive recipients compared to younger donors.
• The findings suggest that elderly donor livers may be best reserved for non-HCV recipients to optimize transplant success.
• While the study was limited by a small cohort of patients receiving older donor livers, the results highlight the importance of donor age in liver transplantation for HCV-positive individuals.