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Multicenter Study
. 2012 May;18(5):532-8.
doi: 10.1002/lt.23396.

Risk of advanced fibrosis with grafts from hepatitis C antibody-positive donors: a multicenter cohort study

Jennifer C Lai  1 , Jacqueline G O'Leary, James F Trotter, Elizabeth C Verna, Robert S Brown Jr, R Todd Stravitz, Jeffrey D Duman, Lisa M Forman, Norah A Terrault; Consortium to Study Health Outcomes in HCV Liver Transplant Recipients (CRUSH-C)
Affiliations
Multicenter Study

Risk of advanced fibrosis with grafts from hepatitis C antibody-positive donors: a multicenter cohort study

Jennifer C Lai et al. Liver Transpl. 2012 May.

Abstract

Over the last decade, the use of liver grafts from hepatitis C virus antibody-positive donors [HCV(+)Ds] has tripled in the United States. Although previous studies have demonstrated no association between an HCV(+)D status and graft loss, the effects of an HCV(+)D on histological outcomes are not well known. Hepatitis C virus (HCV)-infected recipients at 5 US centers (2002-2007) who survived more than 30 days with 1 or more posttransplant biopsy samples were included. Cox regression was used to examine the association between an HCV(+)D status and advanced fibrosis (stage 3/4 or higher). Ninety-nine of the 1206 patients (8%) received an HCV(+)D graft. Recipients of HCV(+)D grafts were older than recipients of hepatitis C virus antibody-negative donor [HCV(-)D] grafts (P = 0.03), but they were otherwise similar. HCV(+)D grafts were significantly lower in quality according to the donor risk index (P < 0.001). Advanced fibrosis occurred in 32% of HCV(+)D graft recipients and in 28% of HCV(-)D graft recipients (P = 0.39). The unadjusted 1- and 3-year rates of advanced fibrosis were significantly higher for HCV(+)D graft recipients (14% and 48%) versus HCV(-)D graft recipients (7% and 33%, P = 0.01). Transplantation with HCV(+)D grafts was associated with a 58% increased risk of advanced fibrosis [95% confidence interval (CI) = 1.05-2.36, P = 0.03]. However, in an analysis stratified by the mean donor age of 45 years, an HCV(+)D status was associated with advanced fibrosis only with donors >45 years old [hazard ratio (HR) = 1.76, 95% CI = 1.06-2.93, P = 0.03] and not with donors ≤45 years old (HR = 0.94, 95% CI = 0.47-1.87, P = 0.85). In conclusion, a careful consideration of the risks and benefits is needed with HCV(+)D grafts. Recipients of HCV(+)D grafts (especially from older donors) should undergo close monitoring for more rapidly progressive fibrosis. Studies are needed to determine whether early HCV therapy modifies this risk.

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Figures

Figure 1
Figure 1
(A) Unadjusted and (B) adjusted cumulative hazard of advanced fibrosis by donor HCV status.
Figure 1
Figure 1
(A) Unadjusted and (B) adjusted cumulative hazard of advanced fibrosis by donor HCV status.
Figure 2
Figure 2
Unadjusted cumulative hazard of advanced fibrosis by donor HCV status among (A) donors ≤ 45 years and (B) donors > 45 years.
Figure 2
Figure 2
Unadjusted cumulative hazard of advanced fibrosis by donor HCV status among (A) donors ≤ 45 years and (B) donors > 45 years.
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