Use of liver grafts from donation after cardiac death donors for recipients with hepatitis C virus

✍ Scribed by C. Burcin Taner; Ilynn G. Bulatao; Andrew P. Keaveny; Darrin L. Willingham; Surakit Pungpapong; Dana K. Perry; Barry G. Rosser; Denise M. Harnois; Jaime Aranda -Michel; Justin H. Nguyen

• Publisher: John Wiley and Sons
• Year: 2011
• Tongue: English
• Weight: 343 KB
• Volume: 17
• Category: Article
• ISSN: 1527-6465
• DOI: 10.1002/lt.22258

✦ Synopsis

Hepatitis C virus (HCV) infection is the most common indication for orthotopic liver transplantation in the United States. Although studies have addressed the use of expanded criteria donor organs in HCV þ patients, to date the use of liver grafts from donation after cardiac death (DCD) donors in HCV þ patients has been addressed by only a limited number of studies. This retrospective analysis was undertaken to study the outcomes of DCD liver grafts used in HCV þ recipients. Seventyseven HCV þ patients who received DCD liver grafts were compared to 77 matched HCV þ patients who received donation after brain death (DBD) liver grafts and 77 unmatched non-HCV patients who received DCD liver grafts. There were no differences in 1-, 3-, and 5-year patient or graft survival among the groups. Multivariate analysis showed that the Model for End-Stage Liver Disease score [hazard ratio (HR) ¼ 1.037, 95% confidence interval (CI) ¼ 1.006-1.069, P ¼ 0.018] and posttransplant cytomegalovirus infection (HR ¼ 3.367, 95% CI ¼ 1.493-7.593, P ¼ 0.003) were significant factors for graft loss. A comparison of the HCV þ groups for fibrosis progression based on protocol biopsy samples up to 5 years post-transplant did not show any difference; in multivariate analysis, HCV genotype 1 was the only factor that affected progression to stage 2 fibrosis (genotype 1 versus non-1 genotypes: HR ¼ 2.739, 95% CI ¼ 1.047-7.143, P ¼ 0.040). In conclusion, this match-controlled, retrospective analysis demonstrates that DCD liver graft utilization does not cause untoward effects on disease progression or patient and graft survival in comparison with DBD liver grafts in HCV þ patients.