Contributions in TransplantationLiver transplantationHepatitis C Virus Recurrence Occurs Earlier in Patients Receiving Donation After Circulatory Death Liver Transplant Grafts Compared With Those Receiving Donation After Brainstem Death Grafts
Section snippets
Methods
This was a retrospective matched case-controlled single-center study of all HCV-positive adults who underwent controlled (Maastricht III) DCD liver transplantation between January 2004 and January 2014 at the Queen Elizabeth Hospital, Birmingham. Of the 1384 adult transplants completed in this period, DCD grafts were used in 208 patients, 49 for HCV-related liver disease. Five patients were excluded because they were found to have been successfully treated for HCV prior to transplantation. A
Results
The 2 groups were well matched for age, sex, and presence of HCC. The mean age at transplant was 55 years; 70 of 88 (80%) patients were men. No significant differences were found between the groups for donor age, HCV genotype, cytomegalovirus (CMV) infection post-transplant, immunosuppression regimens, and rates of rejection requiring steroids (see Table 1). The MELD score at transplantation was higher in DBD recipients than those receiving DCD grafts (median = 13 vs 10; P = .282), which would
Discussion
HCV-related liver disease remains the primary indication for liver transplantation worldwide. Survival is known to be worse than other indications for liver replacement, primarily due to HCV recrudescence shortening graft survival [8]. We are already seeing how highly effective direct acting antiviral therapy reduces short- to medium-term morbidity mortality in both pre- and post-transplant populations, and it is likely that over the next 10 years patient and graft survivals should rise to
Conclusions
In the era of potent DAA therapy, rapid HCV recrudescence in grafts from DCD donors should not compromise long-term morbidity or mortality. HCV remains the primary reason for liver transplantation worldwide and, in an era of burgeoning wait-list mortality, it is prudent to use all available sources to expand the pool of donor organs, including use of grafts from donation after circulatory death. Clinicians should be aware that HCV recrudescence is more rapid in this group and that early
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Use of donation after circulatory death donors in pediatric liver transplantation
2023, Transplantation ReportsImpact of Donation After Circulatory Death Allografts on Outcomes After Liver Transplant for Hepatitis C: A Single-Center Experience and Review of the Literature
2022, Experimental and Clinical Transplantation
S.A.T. is supported by the NIHR Birmingham Liver Biomedical Research Unit based at University Hospitals Birmingham and the University of Birmingham. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.