Live donor liver transplantation with older donors: Increased long-term graft loss due to HCV recurrence

Area of Science:

• Hepatology
• Transplant Surgery
• Virology

Background:

• Hepatitis C virus (HCV) infection is a leading cause of liver disease and liver transplantation.
• Adult living donor liver transplantation (LDLT) is a viable option for HCV-positive patients.
• Donor age is a potential factor influencing LDLT outcomes.

Purpose of the Study:

• To compare the outcomes of LDLT using grafts from younger (<50 years) versus older (≥50 years) donors in adult HCV-positive recipients.
• To evaluate the impact of donor age on post-transplant graft function, complications, HCV recurrence, and long-term survival.

Main Methods:

• Prospective data collection of adult HCV-positive patients undergoing LDLT between October 2000 and May 2014.
• Comparison of outcomes between two donor age groups: younger (<50 years) and older (≥50 years).
• Evaluation of graft function, postoperative complications (Dindo-Clavien score), HCV recurrence, graft survival, and patient survival.

Main Results:

• No significant differences in immediate post-transplant graft function or overall complication rates/severity between younger and older grafts.
• Graft loss due to HCV recurrence was significantly lower in the younger graft group (18% vs. 62%, P=0.001).
• A trend towards improved 1-, 5-, and 10-year graft survival was observed with younger grafts (P=0.096), while patient survival was comparable.

Conclusions:

• LDLT with older donor grafts is associated with a higher risk of long-term graft loss from HCV recurrence in HCV-positive recipients.
• Donor-recipient matching, particularly utilizing younger grafts, is crucial for optimizing long-term outcomes in this patient population.
• Potential differences in graft survival may become more pronounced with extended follow-up periods (≥5 years).