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Immunosuppression and donor age with respect to severity of HCV recurrence after liver transplantation

✍ Scribed by Dimitrios N. Samonakis; Christos K. Triantos; Ulrich Thalheimer; Alberto Quaglia; Gioacchino Leandro; Rosângela Teixeira; George V. Papatheodoridis; Caroline A. Sabin; Nancy Rolando; Susan Davies; Amar P. Dhillon; Paul Griffiths; Vincent Emery; David W. Patch; Brian R. Davidson; Keith Rolles; Andrew K. Burroughs

Publisher
John Wiley and Sons
Year
2005
Tongue
English
Weight
112 KB
Volume
11
Category
Article
ISSN
1527-6465

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✦ Synopsis

In HCV cirrhotic patients after liver transplantation, survival and recurrence of HCV appears to be worsening in recent years. Donor age has been suggested as a cause. However, it is not clear if early and/or late mortality is affected and whether donor age is a key factor, as opposed to changes in immunosuppression. The aim of this study was to assess impact of donor age and other factors with respect to the severity of HCV recurrence posttransplant. A consecutive series of 193 HCV cirrhotic patients were transplanted with cadaveric donors, median age 41.5 years (13-73) and median follow-up of 38 months (1-155). Donor age and other factors were examined in a univariate/multivariate model for early/late survival, as well as fibrosis (grade 4 or more, Ishak score) with regular biopsies, 370 in total, from 1 year onwards. Results of the study indicated that donor age influenced only short-term (3 months) survival, with no significant effect on survival after 3 months. Known HCC independently adversely affected survival, as did the absence of maintenance azathioprine. Severe fibrosis (stage > 4) in 51 patients was related to neither donor age nor year of transplantation, but it was independently associated with combined biochemical/histological hepatitis flare (OR 2.9, 95% CI 1.76-4.9) whereas maintenance steroids were protective (OR 0.4, 95% CI 0.23-0.83). In conclusion, in this cohort donor age did not influence late mortality in HCV transplanted cirrhotic patients or development of severe fibrosis, which was related to absence of maintenance steroids and a hepatitis flare. Maintenance azathioprine gave survival advantage. (

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