Contribution of donor age to the recent decrease in patient survival among HCV-infected liver transplant recipients

Recurrent hepatitis occurs in the majority of patients undergoing liver transplantation for hepatitis C virus (HCV) cirrhosis, with progression to cirrhosis in up to 30% after 5 years. Based on these data, a decrease in survival can be anticipated with prolonged follow-up. Furthermore, posttransplan...

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Bibliographic Details
Published in:Hepatology (Baltimore, Md.) Md.), 2002-07, Vol.36 (1), p.202-210
Main Authors: Berenguer, Marina, Prieto, Martı́n, Juan, Fernando San, Rayón, José M., Martinez, Fernando, Carrasco, Domingo, Moya, Angel, Orbis, Francisco, Mir, José, Berenguer, Joaquı́n
Format: Article
Language:English
Subjects:
Adult
Age Factors
Aged
Biological and medical sciences
Biopsy
Female
Graft Survival
Hepatitis C - mortality
Hepatitis C - pathology
Hepatitis C - surgery
Human viral diseases
Humans
Immunosuppression - adverse effects
Infectious diseases
Liver - pathology
Liver Cirrhosis - mortality
Liver Cirrhosis - surgery
Liver Cirrhosis - virology
Liver Transplantation - mortality
Male
Medical sciences
Middle Aged
Recurrence
Risk Factors
Survival Rate
Tissue Donors
Treatment Outcome
Viral diseases
Viral hepatitis
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Summary:Recurrent hepatitis occurs in the majority of patients undergoing liver transplantation for hepatitis C virus (HCV) cirrhosis, with progression to cirrhosis in up to 30% after 5 years. Based on these data, a decrease in survival can be anticipated with prolonged follow-up. Furthermore, posttransplantation HCV-fibrosis progression has been shown in recent years to increase. Our aims were (1) to describe the natural history of HCV-infected recipients, particularly to determine whether survival has decreased in recent years; (2) to compare this outcome with that observed in non–HCV-infected cirrhosis controls; and (3) to determine the factors associated with disease severity and survival. Among 522 cirrhotic patients undergoing transplantation between 1991 and 2000, 283 (54%) were infected with HCV. Yearly biopsies were performed in these recipients and at 1 and 5 years in the remainder. With similar follow-up, the percentage of deaths in the HCV(+) group was significantly higher than in the HCV(−) group (37% vs. 22%, P < .001), and patient survival was lower (77%, 61%, 55% vs. 87%, 76%, 70% at 1, 5, and 7 years, respectively; P = .0001). Although survival has increased in the HCV(−) group in recent years, it has significantly decreased in HCV recipients ( P < .0001). The main cause of death among the latter was decompensated graft cirrhosis (n = 23/105, 22%), whereas that of HCV(−) patients was infections (n = 10/52, 19%). Reasons for the recent worse outcome in HCV(+) recipients include the increased donor age and stronger immunosuppression. In conclusion, patient survival is lower among HCV(+) recipients than among HCV(−) ones and has been decreasing in recent years. The aging of donors is a major contributor to this worse outcome. (H EPATOLOGY 2002;36:202-210.)
ISSN:0270-9139
1527-3350
DOI:10.1053/jhep.2002.33993