Increased risk of severe recurrence of hepatitis C virus in liver transplant recipients of donation after cardiac death allografts

Transplantation. 2011 Sep 27;92(6):686-9. doi: 10.1097/TP.0b013e31822a79d2.

Abstract

Background: In hepatitis C virus (HCV) recipients of donation after cardiac death (DCD) grafts, there is suggestion of lower rates of graft survival, indicating that DCD grafts themselves may represent a significant risk factor for severe recurrence of HCV.

Methods: We evaluated all DCD liver transplant recipients from August 2006 to February 2011 at our center. Recipients with HCV who received a DCD graft (group 1, HCV+ DCD, n=17) were compared with non-HCV recipients transplanted with a DCD graft (group 2, HCV- DCD, n=15), and with a matched group of HCV recipients transplanted with a donation after brain death (DBD) graft (group 3, HCV+ DBD, n=42).

Results: A trend of poorer graft survival was seen in HCV+ patients who underwent a DCD transplant (group 1) compared with HCV- patients who underwent a DCD transplant (group 2) (P=0.14). Importantly, a statistically significant difference in graft survival was seen in HCV+ patients undergoing DCD transplant (group 1) (73%) as compared with DBD transplant (group 3) (93%)(P=0.01). There was a statistically significant increase in HCV recurrence at 3 months (76% vs. 16%) (P=0.005) and severe HCV recurrence within the first year (47% vs. 10%) in the DCD group (P=0.004).

Conclusions: HCV recurrence is more severe and progresses more rapidly in HCV+ recipients who receive grafts from DCD compared with those who receive grafts from DBD. DCD liver transplantation in HCV+ recipients is associated with a higher rate of graft failure compared with those who receive grafts from DBD. Caution must be taken when using DCD grafts in HCV+ recipients.

MeSH terms

  • Adult
  • Brain Death*
  • Death*
  • Female
  • Graft Survival
  • Hepacivirus / metabolism
  • Hepatitis C / etiology*
  • Hepatitis C / therapy*
  • Humans
  • Liver Transplantation / adverse effects
  • Liver Transplantation / methods*
  • Male
  • Middle Aged
  • Recurrence
  • Retrospective Studies
  • Risk
  • Risk Factors
  • Transplantation, Homologous