The impact of advancing donor age on histologic recurrence of hepatitis C infection: The perils of ignored maternal advice

✍ Scribed by Michael Charlton

• Publisher: John Wiley and Sons
• Year: 2003
• Tongue: English
• Weight: 61 KB
• Volume: 9
• Category: Article
• ISSN: 1527-6465
• DOI: 10.1002/lt.500090516

✦ Synopsis

Recurrent hepatitis occurs in the majority of patients undergoing liver transplantation for hepatitis C virus (HCV) cirrhosis, with progression to cirrhosis in up to 30% after 5 years. Based on these data, a decrease in survival can be anticipated with prolonged follow-up. Furthermore, posttransplantation HCV-fibrosis progression has been shown in recent years to increase. Our aims were (1) to describe the natural history of HCV-infected recipients, particularly to determine whether survival has decreased in recent years; (2) to compare this outcome with that observed in non-HCV-infected cirrhosis controls; and (3) to determine the factors associated with disease severity and survival. Among 522 cirrhotic patients undergoing transplantation between 1991 and 2000, 283 (54%) were infected with HCV. Yearly biopsies were performed in these recipients and at 1 and 5 years in the remainder. With similar follow-up, the percentage of deaths in the HCV(؉) group was significantly higher than in the HCV-group (37% vs. 22%, P <.001), and patient survival was lower (77%, 61%, 55% vs. 87%, 76%, 70% at 1, 5, and 7 years, respectively; P ‫.)1000.؍‬ Although survival has increased in the HCV-group in recent years, it has significantly decreased in HCV recipients (P <.0001). The main cause of death among the latter was decompensated graft cirrhosis (n ‫؍‬ 23/105, 22%), whereas that of HCV-patients was infections (n ‫؍‬ 10/52, 19%). Reasons for the recent worse outcome in HCV؉ recipients include the increased donor age and stronger immunosuppression. In conclusion, patient survival is lower among HCV؉ recipients than among HCV-ones and has been decreasing in recent years. The aging of donors is a major contributor to this worse outcome.