Outcomes in hepatitis C virus-infected recipients of living donor vs. deceased donor liver transplantation

Abstract

In this retrospective study of hepatitis C virus (HCV)-infected transplant recipients in the 9-center Adult to Adult Living Donor Liver Transplantation Cohort Study, graft and patient survival and the development of advanced fibrosis were compared among 181 living donor liver transplant (LDLT) recipients and 94 deceased donor liver transplant (DDLT) recipients. Overall 3-year graft and patient survival were 68% and 74% in LDLT, and 80% and 82% in DDLT, respectively. Graft survival, but not patient survival, was significantly lower for LDLT compared to DDLT (P = 0.04 and P = 0.20, respectively). Further analyses demonstrated lower graft and patient survival among the first 20 LDLT cases at each center (LDLT <or=20) compared to later cases (LDLT > 20; P = 0.002 and P = 0.002, respectively) and DDLT recipients (P < 0.001 and P = 0.008, respectively). Graft and patient survival in LDLT >20 and DDLT were not significantly different (P = 0.66 and P = 0.74, respectively). Overall, 3-year graft survival for DDLT, LDLT >20, and LDLT <or=20 were 80%, 79% and 55%, with similar results conditional on survival to 90 days (84%, 87% and 68%, respectively). Predictors of graft loss beyond 90 days included LDLT <or=20 vs. DDLT (hazard ratio [HR] = 2.1, P = 0.04), pretransplant hepatocellular carcinoma (HCC) (HR = 2.21, P = 0.03) and model for end-stage liver disease (MELD) at transplantation (HR = 1.24, P = 0.04). In conclusion, 3-year graft and patient survival in HCV-infected recipients of DDLT and LDLT >20 were not significantly different. Important predictors of graft loss in HCV-infected patients were limited LDLT experience, pretransplant HCC, and higher MELD at transplantation.

Figure 1

Graft survival after DDLT (dotted line), LDLT ≤20 (dashed line; first 20 cases at each center), and LDLT >20 (solid line; cases beyond the first 20 at each center). Graft survival was significantly lower in LDLT ≤20 compared to LDLT >20 (P = 0.0023) and DDLT (P = 0.0007). However, there was no significant difference in graft survival between LDLT >20 and DDLT (P = 0.66, log-rank test).

Figure 2

Graft survival after DDLT (dotted line), LDLT ≤20 (dashed line; first 20 cases at each center), and LDLT >20 (solid line; cases beyond the first 20 at each center) conditioned on graft survival to at least 90 days. Differences in graft survival were seen in LDLT ≤20 compared to LDLT >20 (P = 0.021) and DDLT (P = 0.052), but there was no significant difference in graft survival between LDLT >20 and DDLT (P = 0.74, log-rank test).

Figure 3

A total of 123 patients had at least 1 biopsy that occurred ≥30 days posttransplantation and no more than 2 weeks after the start of HCV treatment and had an Ishak fibrosis score. The cumulative risk of Ishak fibrosis score of 3 or more (bridging fibrosis or cirrhosis) on biopsy was not significantly different among LDLT ≤20 (solid line; n = 28), LDLT >20 (dashed line; n = 43), and DDLT (dotted line; n = 52) groups (P > 0.05 for all comparisons by log-rank test, unadjusted). Patients were censored at time of treatment of HCV disease.