July 21, 2008 Receiving a liver from a donor older than age 60 does not appear to be associated with transplant failure, death or recurrent disease in the next five years among transplant patients with the hepatitis C virus, according to a new report.
Hepatitis C virus infection is the most common cause of the liver disease cirrhosis and the most common indication for liver transplant for U.S. adults, according to background information in the article. Currently, about 17,000 patients are on the waiting list for a liver transplant. Many medical centers have expanded donor criteria, including increasing age limits, to increase the pool of available organs. "There are concerning reports, however, in recipients with hepatitis C virus that extended criteria donors, particularly older donors, are associated with poorer outcome, especially with early and severe hepatitis C virus recurrence in the donor graft," the authors write.
M.B. Majella Doyle, M.D., and colleagues at Washington University School of Medicine, St. Louis, analyzed data from 489 adult liver transplants performed at the school between 1997 and 2006. Of these patients, 187 (38.2 percent) were infected with the hepatitis C virus and 302 (61.8 percent) had other indications for liver transplant.
Of patients with the hepatitis C virus, 88.1 percent were alive after one year, 78.3 percent survived three years and 69.2 percent survived five years. Donor livers were still functioning in 85.6 percent of hepatitis C virus--positive recipients after one year, 75.6 percent after three years and 65.6 percent after five years. There were no differences in rates of survival and graft (organ) survival between patients with and without hepatitis C in the short or medium term (at one, three or five years). "However, similar to other long-term transplant centers, we observed a negative effect from recurrent hepatitis C virus with a trend toward worsened long-term survival between years five and 10," the authors write.
A total of 72 patients received organs from donors age 60 and older, including 24 (12.8 percent) with hepatitis C virus and 48 (15.9 percent) without the virus. There were no differences in one-, three- or five-year patient or graft survival rates when these patients--or those who received organs from donors age 65 and older--were compared with those who received organs from younger donors. Because the use of older donors has primarily occurred in the past five years, long-term comparisons were not possible. However, the early results suggest the practice is safe, the authors note.
"In conclusion, overall patient and graft survival in hepatitis C virus-positive recipients is comparable with that in hepatitis C virus-negative patients, and there seems to be little, if any, adverse effect on short- and medium-term follow-up with the use of carefully selected older donor grafts in recipients with hepatitis C virus," they conclude. "Data from this series suggest that the continued use of selected older donors is a safe method of expanding the liver donor pool, even for hepatitis C-positive recipients."
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- M. B. Majella Doyle; Christopher D. Anderson; Neeta Vachharajani; Jeffrey A. Lowell; Surendra Shenoy; Mauricio Lisker-Melman; Kevin Korenblat; Jeffrey S. Crippin; William C. Chapman. Liver Transplant for Hepatitis C Virus. Arch Surg., 2008;143(7):679-685 [link]
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