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Patients with the hepatitis C virus who receive a liver from a donorolder than age 60 do not experience a higher rate of transplantfailure, death, or recurrent disease in the following five years,according to a study published in the July issue of Archivesof Surgery.
The most common reason for liver transplants among adults in the UnitedStates is cirrhosis of the liver caused by the hepatitis C viralinfection. Though hospitals have been expanding requirements for donorsto increase the number of eligible organs, about 17,000 patients remainon the waiting list for a liver transplant. One criteria change hasbeen increasing donor age limits. “There are concerning reports,however, in recipients with hepatitis C virus that extended criteriadonors, particularly older donors, are associated with poorer outcome,especially with early and severe hepatitis C virus recurrence in thedonor graft,” note the authors.
To analyze the outcomes of liver transplants from donors of variousages, M.B. Majella Doyle, M.D. (Washington University School ofMedicine, St. Louis) and colleagues used data from 489 adult livertransplants performed between 1997 and 2007. Some of the patientsneeded a liver transplant due to hepatitis C (187 of 489 or 38.2%),while others presented a different indication for transplant (302 of489 or 61.8%).
Survival rates for patients with the hepatitis C virus were: 88.1%after one year, 78.3% after three years, and 69.2% after five years. Inthis group of hepatitis C virus-positive recipients, 85.6% of donorlivers were still functioning after one year, 75.6% after three years,and 65.6% after five years. Among patients with and without hepatitisC, the researchers did not find significant differences in rates ofsurvival and graft survival at one, three, or five years. The authorscaution, however, that, “Similar to other long-term transplant centers,we observed a negative effect from recurrent hepatitis C virus with atrend toward worsened long-term survival between years five and 10.”
Livers from donors who were age 60 and older were transplanted into 72patients - 24 (12.8%) with hepatitis C virus and 48 (15.9%) without thevirus. Patient and graft survival rates at one, three, and five yearsfor patients who received livers from donors age 60 and older were notsignificantly different than survival rates for patients who receivedorgans from younger donors. The researchers also found no difference insurvival rates if the donor was age 65 or older. These results suggestthat the practice of using livers from older donors is safe, accordingto the authors.
The researchers conclude that, “Overall patient and graft survival inhepatitis C virus-positive recipients is comparable with that inhepatitis C virus-negative patients, and there seems to be little, ifany, adverse effect on short- and medium-term follow-up with the use ofcarefully selected older donor grafts in recipients with hepatitis Cvirus…Data from this series suggest that the continued use ofselected older donors is a safe method of expanding the liver donorpool, even for hepatitis C-positive recipients.”
Liver Transplant for Hepatitis C Virus: Effect of Using OlderDonor Grafts on Short- and Medium-Term Survival
M. B. Majella Doyle; Christopher D. Anderson; Neeta Vachharajani;Jeffrey A. Lowell; Surendra Shenoy; Mauricio Lisker-Melman; KevinKorenblat; Jeffrey S. Crippin; William C. Chapman
Archives of Surgery (2008).143[7]: pp. 679- 685.
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Written by: Peter M Crosta
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