By Liz Highleyman

Liver transplantation is the only effective treatment for end-stage liver failure due to chronic hepatitis C virus (HCV) infection, but the availability of the procedure is severely hampered by the shortage of donor organs.

Surgeons have traditionally preferred to use livers from young donors, but increasing the age of acceptable donors could significantly expand the available liver supply.

As reported in the July 2008 Archives of Surgery, researchers from Washington University in St. Louis hypothesized that older donor grafts would provide suitable liver transplant outcomes even in recipients with hepatitis C.

Although hepatitis C is the leading indication for liver transplantation in adults in the U.S., the authors noted as background, it is associated with HCV recurrence in the new liver, increased graft loss, and reduced survival. Some recent studies have indicated that use of older donor organs in recipients with HCV is associated with significantly worse short-term and long-term survival.

The researchers conducted a prospective database analysis that included 489 adult liver transplants performed between January 1997 and June 2006 at the Washington University School of Medicine. Among these patients, 187 had HCV and 302 (61.8%) had other indications for transplantation. The main outcome measures were patient and graft survival, HCV recurrence, and need for and results of re-transplantation.

Results

• Overall, survival rates for patients with HCV were 88.1% at 1 year, 78.3% at 3 years, and 69.2% at 5 years.

• Corresponding graft survival rates were 85.6%, 75.6%, and 65.6%, respectively.

• There was no significant difference in patient or graft survival between patients with and without HCV.

• Rates of recurrent HCV with clinically significant disease were 20% at 1 year and 62% at 10 years.

• 72 recipients received transplants from selected donors age 60 or older, including 24 of 187 (12.8%) patients with HCV and 48 of 302 (15.9%) without HCV.

• No difference was observed in short-term or medium-term patient or graft survival in recipients of grafts from older donors.

Based on these findings, the study authors concluded, "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."

"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 HCV-positive recipients," they added.

Section of Abdominal Transplantation, Department of Surgery and Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St Louis, MO.

9/05/08

Reference
M Doyle, C Anderson, N Vachharajani, and others. Liver transplant for hepatitis C virus: effect of using older donor grafts on short- and medium-term survival. Archives of Surgery 143(7): 679-685. July 2008. (Abstract)