Live donor liver transplantation with older donors: Increased long-term graft loss due to HCV recurrence

Clin Transplant. 2018 Aug;32(8):e13304. doi: 10.1111/ctr.13304. Epub 2018 Jul 16.

Abstract

Using our prospectively collected database all adult hepatitis C virus (HCV)-positive patients receiving an adult-to-adult LDLT between October 2000 and May 2014 were identified. Outcome of LDLT with grafts from younger (<50 years=128) vs older donors (≥50 years=31) was compared. Post-transplant graft function, postoperative complications and incidence of HCV recurrence were evaluated. Long-term graft and patient survival was calculated. No difference in graft function was observed between younger and older grafts. Overall complications were similar between both groups. The severity of complications determined by the Dindo-Clavien score was similar. Graft loss from HCV recurrence was significantly less frequent in younger grafts (18% vs 62%, P = 0.001). Young vs older livers had a trend toward improved 1-, 5-, and 10-year graft survival (89% vs 87%, 77% vs 69%, 70% vs 55%, P = 0.096), while patient survival was comparable between both groups (91% vs 90%, 78% vs 69%, 71% vs 60%, P = 0.25). In conclusion, LDLT with older vs younger grafts are more frequently associated with long-term graft loss due to HCV recurrence. Differences in graft survival might be more prominent with prolonged (≥5-year) follow-up. Living donor-recipient matching is particularly important for younger HCV-positive recipients.

Keywords: hepatitis C Virus; live donor; liver transplantation; older donor age.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Female
  • Follow-Up Studies
  • Graft Rejection / etiology
  • Graft Rejection / mortality*
  • Graft Rejection / pathology
  • Graft Survival*
  • Hepacivirus / isolation & purification*
  • Hepatitis C / mortality*
  • Hepatitis C / surgery
  • Humans
  • Liver Cirrhosis / etiology
  • Liver Cirrhosis / mortality*
  • Liver Cirrhosis / pathology
  • Liver Transplantation / adverse effects
  • Liver Transplantation / mortality*
  • Living Donors / statistics & numerical data*
  • Male
  • Middle Aged
  • Postoperative Complications
  • Prospective Studies
  • Recurrence
  • Risk Factors
  • Survival Rate
  • Tissue and Organ Procurement
  • Treatment Outcome