Older donors: Mounting risks for the hepatitis C-infected liver transplant recipient?

Valadao, Rosa M.; Terrault, Norah A.

doi:10.1002/lt.21801

Cited by 12 publications

(7 citation statements)

References 41 publications

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“…However, the prognostic power of HCV, portal thrombosis and recipient age was less strong than that of D‐MELD even if their role was relevant in cases with a D‐MELD value close to the identified limit of 1628. We failed to demonstrate a prognostic effect of pretransplant abdominal surgery, gender match, gender concordance, CIT and HBcAb‐positivity, although these factors were found significant by other authors (6,9,13,19,31–33). Because of the peculiar donor characteristics, extreme attention was paid to keep the CIT as short as possible.…”

Section: Discussioncontrasting

confidence: 82%

“…The outcome was impaired in cases of a high D-MELD combined with an old recipient and even more so in an old recipient with portal thrombosis. As shown by other authors, HCV typically entails an additional risk, whereas HBV has a protective effect and the effect of the primary disease is generally more evident in the long run (11,13,29,30). However, the prognostic power of HCV, portal thrombosis and recipient age was less strong than that of D-MELD even if their role was relevant in cases with a D-MELD value close to the identified limit of 1628.…”

Section: Discussionmentioning

confidence: 82%

See 1 more Smart Citation

Balancing Donor and Recipient Risk Factors in Liver Transplantation: The Value of D-MELD With Particular Reference to HCV Recipients

Avolio

Cillo

Salizzoni

et al. 2011

American Journal of Transplantation

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Section: Discussioncontrasting

confidence: 82%

Section: Discussionmentioning

confidence: 82%

Balancing Donor and Recipient Risk Factors in Liver Transplantation: The Value of D-MELD With Particular Reference to HCV Recipients

Avolio

Cillo

Salizzoni

et al. 2011

American Journal of Transplantation

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“…As to the risk factors affecting recipient's survival, HCV infection has been well recognized, and it was recently revealed that increased donor age is associated with more severe HCV recurrence [4,5,10]. In our study, there were no significant differences in the survival rates of HCV-positive recipients between the older and younger donor groups, probably because of the small number of cases.…”

Section: Discussioncontrasting

confidence: 54%

Donor Age Affects Liver Regeneration during Early Period in the Graft Liver and Late Period in the Remnant Liver after Living Donor Liver Transplantation

et al. 2012

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Background The aim of the present study was to evaluate the influence of donor age on liver regeneration and surgical outcomes in recipients and donors. Patients and methods Among 101 cases of adult‐to‐adult living donor liver transplantation (LDLT) between March 2002 and March 2011, according to donor age: younger (Y) <50 years of age or older (O) ≥50 years of age, the donors and recipients using right (R) or left (L) graft were divided into groups Y/R (n = 51) and O/R (n = 17), and groups Y/L (n = 26) and O/L (n = 7), respectively. Remnant liver volume (RemLV) and graft liver volume (GLV) were estimated by computed tomography (CT) volumetry. A disintegrin and metalloprotease with thrombospondin type I domain 13 (ADAMTS13) activities and von Willebrand factor (vWF) antigen levels were measured as factors reflecting thrombotic microangiopathy. Results Among the donors, RemLV/total liver volume (TLV) was lower in group O/R than in group Y/R, although there were no significant differences by t‐test with the Bonferroni correction (rough p value = 0.02 at 6 months and rough p value > 0.05 at 1, 3, and 12 months). Donor age (≥50 years) was independently correlated with impaired remnant liver regeneration at 6 months in right lobe LDLT (p = 0.04). Among the recipients, GLV/standard liver volume (SLV) was lower during the first month, although there were no significant differences between the two groups by t‐test with the Bonferroni correction (rough p value = 0.03 at 1 week and rough p value >0.05 at 2 weeks and 1 and 3 months). Donor age (≥50 years) was independently correlated with impaired graft liver regeneration at 1 week in both right and left lobe LDLT (p < 0.05). ADAMTS13 activities were lower in group O/R than in group Y/R, although there were no significant differences by t‐test with the Bonferroni correction (rough p value = 0.049 on postoperative days (POD) 1 and 28 and rough p value >0.05 on POD 7 and 14). vWF/ADAMTW13 ratios were higher on POD 14, although there were no significant differences between the two groups by t‐test with the Bonferroni correction (rough p value = 0.044 on POD 14 and rough p value >0.05 on POD 1, 7, 14, and 28). Conclusions The surgical outcomes using older donor livers for LDLT were comparable to those using younger donor livers. When using older donor livers, however, we should pay attention to the liver volume for recipients as well as donors, because older donor livers might have impaired regenerative ability.

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“…Our study confirmed the deleterious effect of T cell depletive therapy in HCV-positive recipients possibly related to selection of resistant T-cell clones [ 4 ]. We also confirmed accelerated HCV disease course in older donor allografts that suggested an adverse effect of liver senescence [ 18 , 19 ]. Still, it is difficult to include donor age in the transplant decision making process in view of the continued gap between organ availability and demand [ 20 ].…”

Section: Discussionsupporting

confidence: 74%

Hepatitis C in Liver Allograft Recipients: Utility of One-Year Post-Transplantation Biopsy as an Indicator of Antiviral Therapy

Habib

Malik

et al. 2015

Gastroenterol Res

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BackgroundAll-oral interferon-free regimens for hepatitis C viral (HCV) infection are highly efficacious; however, high cost is a barrier to applicability. Liver allograft recipients are particularly likely to benefit from therapy as HCV often leads to graft dysfunction and loss. In this study, we aimed to establish the utility of allograft biopsy at 1 year post-transplant as an indicator of treatment.Methods and ResultsAmong 252 liver recipients enrolled, 136 (54%) developed severe disease (fibrosing cholestatic hepatitis (FCH) or fibrosis stage ≥ 2 at 1 year post-transplant). Multivariable analysis revealed younger recipient age and female gender, older donor age and T cell depletive therapy to be independent predictors of severe disease. Recipients with severe disease had higher rate of further graft loss compared to those with mild disease. Patients with mild disease and sustained virologic response (SVR) had the best survival rate, whereas those with severe disease and viremia had the worst survival (96% versus 63% at 5 years).ConclusionIn conclusion, allograft biopsy at 1 year helps identify recipients at high risk of further graft dysfunction and loss. In view of high cost of therapy, treatment should be preferably directed to high-risk patients including those with FCH or fibrosis stage ≥ 2 by 1 year post-transplant.

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Older donors: Mounting risks for the hepatitis C-infected liver transplant recipient?

Cited by 12 publications

References 41 publications

Balancing Donor and Recipient Risk Factors in Liver Transplantation: The Value of D-MELD With Particular Reference to HCV Recipients

Balancing Donor and Recipient Risk Factors in Liver Transplantation: The Value of D-MELD With Particular Reference to HCV Recipients

Donor Age Affects Liver Regeneration during Early Period in the Graft Liver and Late Period in the Remnant Liver after Living Donor Liver Transplantation

Hepatitis C in Liver Allograft Recipients: Utility of One-Year Post-Transplantation Biopsy as an Indicator of Antiviral Therapy

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