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Risk of advanced fibrosis with grafts from hepatitis C antibody-positive donors: a multicenter cohort study
Jennifer C Lai1, Jacqueline G O'Leary, James F Trotter
1Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, CA 94143, USA.
Insights
Using hepatitis C virus antibody-positive donor [HCV(+)] liver grafts increases the risk of advanced fibrosis, particularly in older donors. Close monitoring for progressive fibrosis is recommended for recipients of HCV(+) donor grafts.
Area of Science:
- Hepatology
- Transplant Surgery
- Virology
Background:
- The use of liver grafts from hepatitis C virus antibody-positive donors (HCV(+)D) has increased significantly.
- Previous research indicated no link between HCV(+)D status and graft loss.
- The impact of HCV(+)D on histological outcomes, specifically fibrosis progression, remains less understood.
Purpose of the Study:
- To investigate the association between HCV(+)D liver grafts and histological outcomes, focusing on advanced fibrosis.
- To determine if HCV(+)D status influences the risk of developing advanced fibrosis (stage 3/4 or higher) post-transplantation.
Main Methods:
- A retrospective study of HCV-infected recipients who underwent liver transplantation in the US between 2002 and 2007.
- Included patients survived >30 days and had at least one post-transplant biopsy.
- Cox regression analysis was employed to assess the relationship between HCV(+)D status and advanced fibrosis, with stratification by donor age.
Main Results:
- HCV(+)D grafts were associated with a 58% increased risk of advanced fibrosis.
- This increased risk was significant in recipients of grafts from donors older than 45 years.
- No significant association was found for grafts from donors 45 years old or younger.
Conclusions:
- HCV(+)D liver grafts, especially from older donors, are linked to a higher risk of advanced fibrosis.
- Careful risk-benefit assessment is crucial when considering HCV(+)D grafts.
- Close patient monitoring for fibrosis progression and further research into early HCV therapy are warranted.
Abstract:
Over the last decade, the use of liver grafts from hepatitis C virus antibody-positive donors [HCV(+)Ds] has tripled in the United States. Although previous studies have demonstrated no association between an HCV(+)D status and graft loss, the effects of an HCV(+)D on histological outcomes are not well known. Hepatitis C virus (HCV)-infected recipients at 5 US centers (2002-2007) who survived more than 30 days with 1 or more posttransplant biopsy samples were included. Cox regression was used to examine the association between an HCV(+)D status and advanced fibrosis (stage 3/4 or higher). Ninety-nine of the 1206 patients (8%) received an HCV(+)D graft. Recipients of HCV(+)D grafts were older than recipients of hepatitis C virus antibody-negative donor [HCV(-)D] grafts (P = 0.03), but they were otherwise similar. HCV(+)D grafts were significantly lower in quality according to the donor risk index (P < 0.001). Advanced fibrosis occurred in 32% of HCV(+)D graft recipients and in 28% of HCV(-)D graft recipients (P = 0.39). The unadjusted 1- and 3-year rates of advanced fibrosis were significantly higher for HCV(+)D graft recipients (14% and 48%) versus HCV(-)D graft recipients (7% and 33%, P = 0.01). Transplantation with HCV(+)D grafts was associated with a 58% increased risk of advanced fibrosis [95% confidence interval (CI) = 1.05-2.36, P = 0.03]. However, in an analysis stratified by the mean donor age of 45 years, an HCV(+)D status was associated with advanced fibrosis only with donors >45 years old [hazard ratio (HR) = 1.76, 95% CI = 1.06-2.93, P = 0.03] and not with donors ≤45 years old (HR = 0.94, 95% CI = 0.47-1.87, P = 0.85). In conclusion, a careful consideration of the risks and benefits is needed with HCV(+)D grafts. Recipients of HCV(+)D grafts (especially from older donors) should undergo close monitoring for more rapidly progressive fibrosis. Studies are needed to determine whether early HCV therapy modifies this risk.
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