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Survival after liver transplantation using hepatitis C virus-positive donor allografts: case-controlled analysis of
Andrew T Burr1, YouFu Li, Jennifer F Tseng
1Department of Surgery, Surgical Outcomes Analysis & Research, University of Massachusetts Medical School, Worcester, MA 01655, USA.
Insights
Using hepatitis C (HCV) positive donor livers for transplantation showed no negative impact on patient or graft survival after adjusting for key factors. This finding challenges previous assumptions about HCV+ allografts in liver transplants.
Area of Science:
- Hepatology
- Transplantation immunology
- Organ donation and procurement
Background:
- Hepatitis C virus (HCV) seropositive allografts have been associated with reduced graft and patient survival in liver transplantation.
- Previous studies have indicated potential risks, leading to cautious use of HCV+ donor organs.
Purpose of the Study:
- To investigate the impact of HCV-seropositive liver allografts on patient and graft survival compared to HCV-negative allografts.
- To conduct a case-controlled analysis using a large organ transplant database.
Main Methods:
- Analysis of 63,149 liver transplants from the UNOS STAR file (1987-2007).
- Creation of a matched case-controlled cohort (n=540 each) using propensity scores, adjusting for 11 donor and recipient variables.
- Estimation of graft and patient survival using Kaplan-Meier curves.
Main Results:
- Unadjusted analysis showed significantly lower graft and patient survival with HCV+ allografts.
- In the propensity score-matched cohort, HCV seropositivity did not significantly affect graft survival (P=0.57).
- Similarly, patient survival was not significantly impacted by HCV+ allografts in the matched cohort (P=0.78).
Conclusions:
- This population-based study demonstrates that after adjusting for donor and recipient characteristics, HCV+ donor liver allografts do not negatively affect patient or graft survival.
- The findings suggest that carefully selected HCV+ liver allografts can be safely utilized in liver transplantation.
- This research provides evidence to potentially expand the donor pool for liver transplantation.
Background:
Numerous reports have documented reduced graft and patient survival after use of hepatitis C (HCV) seropositive allografts in liver transplantation (OLT). We aimed to examine if the use of a HCV+ liver allograft affects patient and graft survivals compared to HCV- donor allografts in a case-controlled analysis of the united network for organ sharing (UNOS) database.
Methods:
We examined 63,149 liver transplants (61,905 donors HCV-; 1,244 donors HCV+) from the UNOS standard transplant analysis and research (STAR) file from 1987 to 2007. Donor and recipient demographics and outcomes were collected in which donor HCV serology was complete. A case-controlled cohort from 11 donor and recipient variables comparing donor HCV- and HCV+ allografts (n=540 in each group) was created using propensity scores with a matching algorithm. Graft and patient survival was estimated using Kaplan-Meier survival curves.
Results:
Significant differences were evident in the unadjusted cohort between recipients who received HCV+ and HCV- allografts, including HCV+ recipients, donor and recipient age, and model for end-stage liver disease (MELD) exception cases. Use of HCV+ allograft resulted in significantly lower graft survival (8.1 vs. 10.6 years; P=0.001) and patient survival (10.2 vs. 12.3 years; P=0.01) after OLT. In the matched cohort, HCV seropositivity had no detrimental effect on the graft (P=0.57) or patient (P=0.78) survival after OLT.
Conclusions:
This is the first population-based analysis to show that after adjusting for donor and recipient characteristics there was no difference in graft or patient survival with the use of HCV+ donor liver allografts compared to HCV- donor liver allografts.
