Differential Effects of Donor Age in Liver Transplant Recipients Infected With Hepatitis B, Hepatitis C and Without Viral Hepatitis

Abstract

The variable impact of specific risk factors on survival outcomes based on pre-transplantation diagnosis was analyzed in adult liver transplant recipients reported to the Scientific Registry of Transplant Recipients: 778 with hepatitis B (HBV), 3463 with hepatitis C (HCV) and 7429 without viral hepatitis. Graft and patient survival for the HBV and no viral hepatitis groups did not differ significantly. The HCV group had significantly lower graft (p = 0.0019) and patient survival (p < 0.0001) than the no viral hepatitis group. Patient survival was significantly lower (p = 0.0011) for HCV compared to HBV patients; differences in graft survival approached significance (p = 0.0561). Donor age, which was not a risk factor in patients with HBV, was the strongest predictor of graft loss and death in patients with HCV, starting with donors >40 years. Donor age >60 years was the strongest predictor of graft loss and death in patients without viral hepatitis. The risks of graft loss and death were reduced for patients on tacrolimus-based immunosuppression with mycophenolate mofetil, regardless of disease etiology. There are clear differences in risk factors for poor outcomes based on underlying liver disease, particularly with regard to the impact of donor age.

Initial Poor Graft Dysfunction and Primary Graft Non-Function After Orthotopic Liver Transplantation

“…In the study by Feng et al, donor age over 40 years was associated significantly with the relative risk of graft failure (Feng et al, 2006). In the multivariate analysis by Lake et al, donor age over 40 was related with a 1.67 increased risk of graft failure in HCV-infected recipients and with 2.21 increased risk of graft failure when donor age was more than 60 years (Lake et al, 2005). In the SRTR analysis by Johnson et al, donor age more than 40 years was an independent factor for the prediction of PGNF (Johnson et al, 2007).…”

Strategies to reduce hepatitis C virus recurrence after liver transplantation

“…In contrast, Samonakis et al [43] found that absence of maintenance steroids and azathioprine but not donor age influenced severity of HCV recurrence. Lake et al [44] analyzed data from the American Scientific Registry of Transplant Recipients, looking at the effect of donor age on the outcome of 778 hepatitis B, 3463 hepatitis C and 7429 nonviral recipients. Donor age was not a risk factor for HBV recipients, but was the strongest predictor for graft loss in HCV recipients.…”

Donor Factors Including Donor Risk Index Predict Fibrosis Progression, Allograft Loss, and Patient Survival following Liver Transplantation for Hepatitis C Virus

“…Prior studies have indicated that advanced donor age contributes to impaired outcomes in patients transplanted for HCV. [16][17][18][19] However, conflicting data exist regarding the impact of recipient age on post-LT outcome for HCV. 20,21 In our series, we could find no relationship between recipient factors and outcomes.…”