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Liver transplant for hepatitis C virus: effect of using older donor grafts on short- and medium-term survival.
Arch Surg 2008; 143(7):679-85; discussion 685AS

Abstract

HYPOTHESIS

Older donor grafts will provide suitable results of liver transplant, even in recipients with hepatitis C virus (HCV). Although HCV remains the leading indication for liver transplant in adults in the United States, it is associated with HCV recurrence, increased graft loss, and reduced survival. In addition, recent studies suggest that the use of older donors in recipients with HCV is associated with significantly worsened short- and long-term survival.

DESIGN

Prospective database analysis.

SETTING

Washington University School of Medicine.

PATIENTS

Between January 1, 1997, and June 30, 2006, a total of 579 liver transplants were performed. Ninety pediatric transplants were excluded. Of the remaining 489 adult patients (84.5%), 187 (38.2%) had HCV and 302 (61.8%) had other indications.

MAIN OUTCOME MEASURES

Patient and graft survival, recurrence of HCV, and need for and results of retransplant.

RESULTS

At 1, 3, and 5 years, overall patient survival was 88.1%, 78.3%, and 69.2%, respectively, and graft survival was 85.6%, 75.6%, and 65.6%, respectively, in patients with HCV. There was no significant difference in patient or graft survival between patients with and those without HCV. Recurrent HCV with clinically significant disease was 20% at 1 year and 62% at 10 years. Seventy-two patients received transplants from donors 60 years or older (24 of 187 [12.8%] with HCV and 48 of 302 [15.9%] without HCV). No difference was demonstrated in short- or medium-term patient or graft survival in recipients of grafts from older donors.

CONCLUSION

The increasing use of marginal donors, including carefully selected older donors, does not seem to adversely affect short- or medium-term results and may be a source of additional organs for expanding liver transplant waiting lists.

Authors+Show Affiliations

Department of Surgery, Section of Abdominal Transplantation, Washington University School of Medicine, St Louis, Missouri 63110, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18645111

Citation

Doyle, M B Majella, et al. "Liver Transplant for Hepatitis C Virus: Effect of Using Older Donor Grafts On Short- and Medium-term Survival." Archives of Surgery (Chicago, Ill. : 1960), vol. 143, no. 7, 2008, pp. 679-85; discussion 685.
Doyle MB, Anderson CD, Vachharajani N, et al. Liver transplant for hepatitis C virus: effect of using older donor grafts on short- and medium-term survival. Arch Surg. 2008;143(7):679-85; discussion 685.
Doyle, M. B., Anderson, C. D., Vachharajani, N., Lowell, J. A., Shenoy, S., Lisker-Melman, M., ... Chapman, W. C. (2008). Liver transplant for hepatitis C virus: effect of using older donor grafts on short- and medium-term survival. Archives of Surgery (Chicago, Ill. : 1960), 143(7), pp. 679-85; discussion 685. doi:10.1001/archsurg.143.7.679.
Doyle MB, et al. Liver Transplant for Hepatitis C Virus: Effect of Using Older Donor Grafts On Short- and Medium-term Survival. Arch Surg. 2008;143(7):679-85; discussion 685. PubMed PMID: 18645111.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Liver transplant for hepatitis C virus: effect of using older donor grafts on short- and medium-term survival. AU - Doyle,M B Majella, AU - Anderson,Christopher D, AU - Vachharajani,Neeta, AU - Lowell,Jeffrey A, AU - Shenoy,Surendra, AU - Lisker-Melman,Mauricio, AU - Korenblat,Kevin, AU - Crippin,Jeffrey S, AU - Chapman,William C, PY - 2008/7/23/pubmed PY - 2008/8/6/medline PY - 2008/7/23/entrez SP - 679-85; discussion 685 JF - Archives of surgery (Chicago, Ill. : 1960) JO - Arch Surg VL - 143 IS - 7 N2 - HYPOTHESIS: Older donor grafts will provide suitable results of liver transplant, even in recipients with hepatitis C virus (HCV). Although HCV remains the leading indication for liver transplant in adults in the United States, it is associated with HCV recurrence, increased graft loss, and reduced survival. In addition, recent studies suggest that the use of older donors in recipients with HCV is associated with significantly worsened short- and long-term survival. DESIGN: Prospective database analysis. SETTING: Washington University School of Medicine. PATIENTS: Between January 1, 1997, and June 30, 2006, a total of 579 liver transplants were performed. Ninety pediatric transplants were excluded. Of the remaining 489 adult patients (84.5%), 187 (38.2%) had HCV and 302 (61.8%) had other indications. MAIN OUTCOME MEASURES: Patient and graft survival, recurrence of HCV, and need for and results of retransplant. RESULTS: At 1, 3, and 5 years, overall patient survival was 88.1%, 78.3%, and 69.2%, respectively, and graft survival was 85.6%, 75.6%, and 65.6%, respectively, in patients with HCV. There was no significant difference in patient or graft survival between patients with and those without HCV. Recurrent HCV with clinically significant disease was 20% at 1 year and 62% at 10 years. Seventy-two patients received transplants from donors 60 years or older (24 of 187 [12.8%] with HCV and 48 of 302 [15.9%] without HCV). No difference was demonstrated in short- or medium-term patient or graft survival in recipients of grafts from older donors. CONCLUSION: The increasing use of marginal donors, including carefully selected older donors, does not seem to adversely affect short- or medium-term results and may be a source of additional organs for expanding liver transplant waiting lists. SN - 1538-3644 UR - https://www.unboundmedicine.com/medline/citation/18645111/Liver_transplant_for_hepatitis_C_virus:_effect_of_using_older_donor_grafts_on_short__and_medium_term_survival_ L2 - https://jamanetwork.com/journals/jamasurgery/fullarticle/10.1001/archsurg.143.7.679 DB - PRIME DP - Unbound Medicine ER -