Studies have suggested that the use of hepatitis C virus (HCV)-positive (HCVϩ) donor allografts has no impact on survival. However, no studies have examined the effect that HCVϩ donor histology has upon recipient and graft survival. We evaluated the clinical outcome and impact of histological features in HCV patients transplanted using HCVϩ livers. We reviewed all patients transplanted for HCV at our institution from 1988 to 2004; 39 received HCVϩ allografts and 580 received HCVnegative (HCVϪ) allografts. Survival curves compared graft and patient survival. Each HCVϩ allograft was stringently matched to a control of HCVϪ graft recipients. No significant difference in survival was noted between recipients of HCVϩ livers and controls. Patients receiving HCVϩ allografts from older donors (age Ն50 yr) had higher rates of graft failure (hazard ratio, 2.74) and death rates (hazard ratio, 2.63) compared to HCVϪ allograft recipients receiving similarly-aged older donor livers. Matched case-control analysis revealed that recipients of HCVϩ allografts had more severe fibrosis post-liver transplantation than recipients of HCVϪ livers (P ϭ 0.008). More advanced fibrosis was observed in HCVϩ grafts from older donors compared to HCVϩ grafts from younger donors (P ϭ 0.012). In conclusion, recipients of HCVϩ grafts from older donors have higher rates of death and graft failure, and develop more extensive fibrosis than HCVϪ graft recipients from older donors. Recipients of HCVϩ grafts, regardless of donor age, develop more advanced liver fibrosis than recipients of HCVϪ grafts.

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