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Long-term outcome of patients transplanted with livers from hepatitis C-positive donors
G Testa1, R M Goldstein, G Netto
1Transplantation Services, Baylor University Medical Center, Dallas, Texas 75246, USA.
Insights
Using hepatitis C (Hep C) positive donor organs for liver transplants is safe and effective. Long-term patient and graft survival rates are comparable to those receiving Hep C negative donor organs.
Area of Science:
- Hepatology
- Transplantation immunology
- Virology
Background:
- Hepatitis C (Hep C) end-stage liver disease patients may receive organs from Hep C serology-positive donors.
- Previous short-term studies indicated no difference in early survival rates.
- This review evaluates long-term outcomes (≥1 year) of Hep C+ donor grafts.
Purpose of the Study:
- To confirm the safety and efficacy of using Hep C+ donor grafts in liver transplantation.
- To compare long-term patient and graft survival rates between Hep C+ and Hep C- donor recipients.
Main Methods:
- Retrospective analysis of 213 patients diagnosed with Hep C undergoing transplantation between 1985-1995.
- Comparison of 22 patients receiving Hep C+ donor grafts versus 115 patients receiving Hep C- donor grafts.
- Assessment of Hep C recurrence rate and severity via serial biopsies, alongside patient and graft survival analysis.
Main Results:
- Hep C recurrence observed in 54.55% of Hep C+ donor recipients vs. 41.74% in Hep C- recipients (P=NS).
- Mild chronic hepatitis was the most common recurrence in both groups.
- Four-year patient survival was 83.9% (Hep C+) vs. 79.1% (Hep C-), and graft survival was 71.9% (Hep C+) vs. 76.2% (Hep C-) (P=NS).
Conclusions:
- Hepatitis C positive donor grafts can be utilized with excellent long-term outcomes.
- The pre-existence of hepatitis C virus in the donor does not appear to negatively impact recurrent disease progression.
- Transplantation using Hep C+ donors is a viable option for eligible patients.
Background:
The use of hepatitis C serology-positive donors has become an option in patients affected by hepatitis C (Hep C) end-stage liver disease. Previous studies with less than 1 year of follow-up have suggested that there is no difference in early patient and graft survival. The aim of our review is to confirm with a longer follow-up (a minimum of 1 year) that the use of these organs is safe and that patient and graft survival are comparable to those of patients with Hep C who received Hep C-negative grafts.
Methods:
Between 1985 and 1995, 213 patients were transplanted with a diagnosis of Hep C. Seventy-six patients were excluded from the study, 47 for insufficient follow-up and 29 because the diagnosis of recurrence was not certain. Twenty-two patients received Hep C+ donor grafts and 115 patients received Hep C-donor grafts. These two groups were evaluated to assess the rate and severity of recurrence by serial biopsies and to assess patient and graft survival.
Results:
Recurrent Hep C was documented by biopsy in 12 of 22 patients who received Hep C+ donor grafts. Of these 12 patients, 9 had mild chronic hepatitis, 2 had fibrosis, and 1 had cirrhosis. Ten of the 22 patients had normal biopsies. Of the patients who received Hep C- grafts, 48 of 115 had recurrent disease. Of these 48 patients, 23 had mild chronic hepatitis, 15 had fibrosis, and 10 had cirrhosis. Sixty-seven of 115 had normal biopsies. The recurrence rate was 54.55% in the Hep C+ donor grafts and 41.74% in the Hep C- donor grafts (P=NS). Patient and graft survival at 4 years after transplant were 83.9% and 71.9% in the Hep C+ donor grafts and 79.1% and 76.2% in the Hep C- donor grafts, respectively (P=NS).
Conclusions:
Our study suggests that Hep C+ donors can be used with excellent long-term results and that the progression of the recurrent disease does not seem to be affected by the pre-existence of the Hep C virus in the donor.