The outcome of liver grafts procured from hepatitis C-positive donors

Velidedeoğlu, Ergun; Desai, Niraj M.; Campos, Louis; Olthoff, Kim M.; Shaked, Abraham; Nunes, Frederick A.; Zeldin, Gillian; Stewart, Campbell L.; Blumberg, Emily A.; Abrams, John; Markmann, James F.

doi:10.1097/00007890-200202270-00018

Cited by 96 publications

(72 citation statements)

References 9 publications

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“…Previous studies have demonstrated equivalent incidence of recurrence in recipients of HCVϩ donor grafts, [7][8][9][10][11][12] and, most recently, equivalent time to biopsy-proven HCV recurrence. 14 Our results suggest that patients receiving HCVϩ donor organs develop more fibrosis over time than those receiving HCVϪ grafts.…”

Section: Discussionmentioning

confidence: 99%

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Impact of donor age on survival and fibrosis progression in patients with hepatitis C undergoing liver transplantation using HCV+ allografts

et al. 2006

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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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Section: Discussionmentioning

confidence: 99%

“…[7][8][9][10][11][12][13] Saab et al 14 recently reported no difference in patient survival, graft survival, or time to HCV recurrence in 59 recipients of HCVϩ grafts com-pared to matched recipients of HCV-negative (HCVϪ) grafts. The authors did not comment on whether the donor age or allograft features impacted survival.…”

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confidence: 99%

Impact of donor age on survival and fibrosis progression in patients with hepatitis C undergoing liver transplantation using HCV+ allografts

et al. 2006

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“…They analyzed 7,811 HCV Ϫ patients who received an HCV Ϫ graft, 5,053 HCV ϩ patients who received a noninfected graft, and 190 HCV ϩ patients who received an HCV ϩ graft. Analysis showed that survival for HCV ϩ recipients of HCV ϩ grafts at 3 years was similar to that of HCV ϩ recipients of HCV Ϫ grafts (73% v 69%) 16 (Fig. 2).…”

Section: Clinical Outcomesmentioning

confidence: 70%

“…[12][13][14] Some new studies with larger numbers of patients and longer follow-up have cleared more questions regarding virological changes and clinical outcome. [15][16][17] Virological Behavior HCV ϩ patients receiving an HCV ϩ graft create an exceptional human system to study the interaction between two different viral strains. Laskus et al 18 had access to 14 such donor-recipient pairs, for whom very closely spaced serum samples were available in the post-OLT period.…”

Section: Hcv ؉ Donors In Hcv ؉ Recipientsmentioning

confidence: 99%

“…[12][13][14] However, these results might be affected by very small sample sizes and may be biased by the limited number of centers. Using the UNOS data set, Velidedeoglu et al 16 analyzed a subset of 14,195 patients with known donor and recipient HCV serological test results from 1995 to 1999. They analyzed 7,811 HCV Ϫ patients who received an HCV Ϫ graft, 5,053 HCV ϩ patients who received a noninfected graft, and 190 HCV ϩ patients who received an HCV ϩ graft.…”

Section: Clinical Outcomesmentioning

confidence: 99%

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The use of hepatitis C-infected grafts in liver transplantation

Arenas

Vargas

Rakela

2003

Liver Transplantation

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O rthotopic liver transplantation (OLT) has become the definitive procedure for management of end-stage liver disease, with survival rates greater than 80% at 1 year. Therefore, as absolute contraindications have progressively decreased, the number of indications has proportionately increased. Unfortunately, mortality on the waiting list has increased because of the disparity between number of donors and the rapid growth in number of candidates. According to the United Network for Organ Sharing (UNOS), the number of patients on the waiting list increased from 1,527 patients in 1991 to 16,874 patients in 2000, and the number of deaths while waiting increased from 515 to 1,661 deaths in the same period. 1 Patients with hepatitis C make up the largest segment of the candidate pool, continuing to stress the ability to provide grafts to those in need. In North America, most centers report hepatitis C virus (HCV) infection in greater than 40% of their candidates.To solve the problem of donor organ availability, several approaches have been explored. One approach is the use of organs from less-than-perfect donors, also called marginal donors. These could include nonheart-beating donors, older donors (age Ͼ 65 years), donors with morbid obesity, and last, donors infected with hepatotropic viruses, specifically HCV and hepatitis B virus. This review focuses on the development of the latter practice and its virological consideration, and we suggest recommendations on how these organs should be allocated. HCV-Infected Grafts Transmission of HCV by Donor OrgansIn 1990, the first report of HCV transmission from organ donor to recipient was made, followed by several successive reports. 2,3 With more sensitive and specific techniques, Pereira et al 4 reported that virtually all organ recipients from anti-HCV-positive (HCV ؉ ) donors become infected with the virus. Another study from the United Kingdom by Wreghitt et al 5 found a transmission rate of 93%, in which 50% of recipients of HCV ϩ organs had evidence of HCV-related liver disease after OLT. HCV seroprevalence in their donor pool was 1.08%. 5 The New England Organ Bank retrospectively evaluated clinical outcomes of recipients of organs from HCV ϩ and HCV-negative (HCV ؊ ) donors. 6 Between 1986 and 1990, a total of 29 patients received organs from 13 HCV ϩ donors (determined by a first-generation enzyme-liked immunosorbent assay). They were compared with 74 recipients of grafts from 35 HCV Ϫ donors. Median posttransplantation follow-ups for the HCV ϩ and HCV Ϫ groups were 42 and 49 months, and relative risk for the development of hepatitis in the HCV ϩ group was 4.37. 6 Using the National Institute of Diabetes and Digestive and Kidney Diseases Liver Transplantation Database, Everhart et al 7 prospectively evaluated 702 liver transplant recipients and 604 donors who were tested for antibody to HCV, followed by recombinant immunoblot and HCV RNA confirmation by polymerase chain reaction. Fifteen donors were HCV ϩ by either antibody to HCV or polymerase chain reaction. Eig...

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Hepatitis C in Organ Donors and Heart Transplant Recipients

Taylor¹,

Fontana²

2007

JAMA

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The outcome of liver grafts procured from hepatitis C-positive donors

Cited by 96 publications

References 9 publications

Impact of donor age on survival and fibrosis progression in patients with hepatitis C undergoing liver transplantation using HCV+ allografts

Impact of donor age on survival and fibrosis progression in patients with hepatitis C undergoing liver transplantation using HCV+ allografts

The use of hepatitis C-infected grafts in liver transplantation

Hepatitis C in Organ Donors and Heart Transplant Recipients

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