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Donor hepatitis C sero-status does not impact survival in liver transplantation
Martin I Montenovo1, Andre A S Dick2, Ryan N Hansen3
1Department of Surgery, Division of Transplantation, University of Washington, Seattle, WA, USA.
Insights
Hepatitis C virus (HCV) positive donor organs can be safely used in HCV positive liver transplant recipients, showing equivalent survival rates. This finding supports increased consideration of HCV+ donors given organ scarcity.
Area of Science:
- Hepatology
- Transplantation Immunology
- Public Health
Background:
- Hepatitis C virus (HCV) is a leading cause of liver disease and liver transplantation (LT) in the US.
- Recurrent HCV infection post-LT significantly impacts patient and graft survival.
- Organ scarcity drives the utilization of HCV-positive (HCV+) donor organs.
Purpose of the Study:
- To estimate the impact of using HCV+ donor organs on patient and graft survival after liver transplantation.
- To compare outcomes between HCV+ recipients receiving HCV+ versus HCV- donor organs.
Main Methods:
- A cohort study of adult LT recipients (2002-2012) using United Network for Organ Sharing (UNOS) data.
- Comparison of patient characteristics between HCV+ and HCV- recipients.
- Kaplan-Meier and Cox regression models to assess patient and graft survival.
Main Results:
- Among 59,899 LT recipients, 1,695 (2.8%) received HCV+ grafts.
- HCV+ recipients had inferior survival compared to HCV- recipients.
- However, HCV+ recipients receiving HCV+ grafts showed equivalent patient and graft survival compared to those receiving HCV- grafts.
Conclusions:
- Utilizing HCV+ donor grafts in HCV+ recipients is not associated with worse patient or graft survival.
- Increased consideration of HCV+ donors is warranted due to the rising number of HCV+ patients awaiting transplantation.
Background:
Liver disease caused by hepatitis C virus (HCV) is the main indication for liver transplantation (LT) among adults in the US. Recurrent HCV impairs patient and graft survival after LT. The high prevalence of HCV along with scarce organs has lead to increased utilization of HCV+ organs. We estimated the impact of HCV+ donors on patient and graft survival.
Material And Methods:
We conducted a cohort study of LT recipients age 18 years or older from February 2002 through December 2012 utilizing UNOS data. We evaluated differences in patient characteristics between HCV+ and HCV- recipients. We also compared patient and graft survival between these groups and among HCV+ recipients who received HCV+ versus HCV- donor organs using the Kaplan-Meier estimator and multivariate stratified Cox regression models.
Results:
We identified 59,899 LT recipients. Among those, 1,695 (2.8%) were HCV+ who received HCV+ grafts. HCV+ recipients of HCV- grafts were more likely to be female, hospitalized, in the ICU, on a ventilator, had higher MELD scores, and higher bilirubin. Patient and graft survival at 1, 5, and 10 years in HCV+ recipients was inferior to HCV- recipients, but HCV+ recipients who received HCV+ versus HCV- grafts were equivalent. Multivariate regression revealed multiple variables associated with worse outcomes.
Conclusions:
The use of HCV+ grafts in HCV+ recipients is not associated with worse outcomes. With the increase in HCV+ patients awaiting an organ, more consideration should be given to HCV+ donors.
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