Elsevier

Transplantation Proceedings

Volume 49, Issue 9, November 2017, Pages 2129-2134
Transplantation Proceedings

Contributions in Transplantation
Liver transplantation
Hepatitis C Virus Recurrence Occurs Earlier in Patients Receiving Donation After Circulatory Death Liver Transplant Grafts Compared With Those Receiving Donation After Brainstem Death Grafts

https://doi.org/10.1016/j.transproceed.2017.07.016Get rights and content

Highlights

  • This article reports the experience of the UK's largest liver transplant centre of patients receiving DCD liver grafts and compares their outcomes to a matched cohort of individuals receiving DBD liver grafts for hepatitis C-related liver disease.

  • HCV recurrence was more rapid in DCD recipients; other risk factors were CMV infection and steroid use post-transplantation.

  • Five-year patient and graft survival and rates of biliary complications were equal in both groups.

  • On average DCD donor age was 10 years older than in other published cohorts, supporting the uses of extended-criteria DCD grafts.

  • In an era of highly effective DAA therapy, rapid HCV recrudescence in grafts from DCD donors should not compromise long-term morbidity or mortality, but clinicians should be aware that early post-transplant antiviral therapy is indicated to prevent graft injury.

Abstract

Introduction

Hepatitis C virus (HCV)-related cirrhosis remains the commonest indication for liver transplantation worldwide, yet few studies have investigated the impact of donation after circulatory death (DCD) graft use on HCV recurrence and patient outcomes. DCD grafts have augmented the limited donor organ pool and reduced wait-list mortality, although concerns regarding graft longevity and patient outcome persist.

Methods

This was a single-center study of all HCV + adults who underwent DCD liver transplantation between 2004 and 2014. 44 HCV+ patients received DCD grafts, and were matched with 44 HCV+ recipients of donation after brainstem death (DBD) grafts, and their outcomes examined.

Results

The groups were matched for age, sex, and presence of hepatocellular carcinoma; no significant differences were found between the group's donor or recipient characteristics. Paired and unpaired analysis demonstrated that HCV recurrence was more rapid in recipients of DCD organs compared with DBD grafts (408 vs 657 days; P = .006). There were no significant differences in graft survival, patient survival, or rates of biliary complications between the cohorts despite DCD donors being 10 years older on average than those used in other published experience.

Conclusions

In an era of highly effective direct acting antiviral therapy, rapid HCV recrudescence in grafts from DCD donors should not compromise long-term morbidity or mortality. In the context of rising wait-list mortality, it is prudent to use all available sources to expand the pool of donor organs, and our data support the practice of using extended-criteria DCD grafts based on donor age. Notwithstanding that, clinicians should be aware that HCV recrudescence is more rapid in DCD recipients, and early post-transplant anti-viral therapy is indicated to prevent graft injury.

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

References (13)

There are more references available in the full text version of this article.

Cited by (2)

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.

View full text