Outcomes in hepatitis C virus–infected recipients of living donor vs. deceased donor liver transplantation

✍ Scribed by Norah A. Terrault; Mitchell L. Shiffman; Anna S.F. Lok; Sammy Saab; Lan Tong; Robert S. Brown Jr.; Gregory T. Everson; K. Rajender Reddy; Jeffrey H. Fair; Laura M. Kulik; Timothy L. Pruett; Leonard B. Seeff

• Publisher: John Wiley and Sons
• Year: 2006
• Tongue: English
• Weight: 166 KB
• Volume: 13
• Category: Article
• ISSN: 1527-6465
• DOI: 10.1002/lt.20995

✦ Synopsis

In this retrospective study of hepatitis C virus (HCV)-infected transplant recipients in the 9-center Adult to Adult Living Donor Liver Transplantation Cohort Study, graft and patient survival and the development of advanced fibrosis were compared among 181 living donor liver transplant (LDLT) recipients and 94 deceased donor liver transplant (DDLT) recipients. Overall 3-year graft and patient survival were 68% and 74% in LDLT, and 80% and 82% in DDLT, respectively. Graft survival, but not patient survival, was significantly lower for LDLT compared to DDLT (P ϭ 0.04 and P ϭ 0.20, respectively). Further analyses demonstrated lower graft and patient survival among the first 20 LDLT cases at each center (LDLT 20) compared to later cases (LDLT Ͼ 20; P ϭ 0.002 and P ϭ 0.002, respectively) and DDLT recipients (P Ͻ 0.001 and P ϭ 0.008, respectively). Graft and patient survival in LDLT Ͼ20 and DDLT were not significantly different (P ϭ 0.66 and P ϭ 0.74, respectively). Overall, 3-year graft survival for DDLT, LDLT Ͼ20, and LDLT 20 were 80%, 79% and 55%, with similar results conditional on survival to 90 days (84%, 87% and 68%, respectively). Predictors of graft loss beyond 90 days included LDLT 20 vs. DDLT (hazard ratio [HR] ϭ 2.1, P ϭ 0.04), pretransplant hepatocellular carcinoma (HCC) (HR ϭ 2.21, P ϭ 0.03) and model for end-stage liver disease (MELD) at transplantation (HR ϭ 1.24, P ϭ 0.04). In conclusion, 3-year graft and patient survival in HCV-infected recipients of DDLT and LDLT Ͼ20 were not significantly different. Important predictors of graft loss in HCV-infected patients were limited LDLT experience, pretransplant HCC, and higher MELD at transplantation.