TY - JOUR
T1 - Restricting liver transplant recipients to younger donors does not increase the wait-list time or the dropout rate
T2 - The hepatitis C experience
AU - Flemming, Jennifer A.
AU - Vagefi, Parsia A.
AU - Freise, Chris E.
AU - Yao, Francis Y.
AU - Terrault, Norah A.
N1 - Publisher Copyright:
© 2014 AASLD.
PY - 2014/10/1
Y1 - 2014/10/1
N2 - Older donor age is associated with lower graft and patient survival among all recipients of liver transplantation (LT). Among patients with hepatitis C virus (HCV), donor age is one of the strongest predictors of fibrosis severity and graft loss. We evaluated the implementation of a donor age restriction policy for LT patients with HCV at a single center and the effects that this policy had on wait-list (WL) and post-LT outcomes for HCV and non-HCV patients. This was a cohort study of 2388 WL patients and 1015 LT recipients between March 2002 and January 2013 and reflected 3 different eras of donor age policies. With the donor age restriction, the median donor age was reduced in LT recipients with HCV versus LT recipients without HCV (30 versus 48 years, P<0.001) without differences in the WL time (10.6 versus 8.0 months, P=0.23). According to a competing risks regression, those with HCV and those without HCV had lower subhazard ratios (SHRs) of dropout or death on the WL during the donor age restriction era versus the era without donor age restriction [SHR50.68 (P<0.01) and SHR=0.64 (P=0.01), respectively]. No differences were seen in early post-LT survival for patients with or without HCV between eras (P=0.7 and P=0.88, respectively). In conclusion, we show that donor age restriction for HCV results in a lower donor age for HCV recipients without obvious adverse WL consequences. Although additional studies are needed, our results demonstrate the feasibility of donor age restriction for LT recipients with HCV, and such information may be relevant to programs with limited access to new antiviral therapies for which modifying the risk of severe disease remains of paramount importance.
AB - Older donor age is associated with lower graft and patient survival among all recipients of liver transplantation (LT). Among patients with hepatitis C virus (HCV), donor age is one of the strongest predictors of fibrosis severity and graft loss. We evaluated the implementation of a donor age restriction policy for LT patients with HCV at a single center and the effects that this policy had on wait-list (WL) and post-LT outcomes for HCV and non-HCV patients. This was a cohort study of 2388 WL patients and 1015 LT recipients between March 2002 and January 2013 and reflected 3 different eras of donor age policies. With the donor age restriction, the median donor age was reduced in LT recipients with HCV versus LT recipients without HCV (30 versus 48 years, P<0.001) without differences in the WL time (10.6 versus 8.0 months, P=0.23). According to a competing risks regression, those with HCV and those without HCV had lower subhazard ratios (SHRs) of dropout or death on the WL during the donor age restriction era versus the era without donor age restriction [SHR50.68 (P<0.01) and SHR=0.64 (P=0.01), respectively]. No differences were seen in early post-LT survival for patients with or without HCV between eras (P=0.7 and P=0.88, respectively). In conclusion, we show that donor age restriction for HCV results in a lower donor age for HCV recipients without obvious adverse WL consequences. Although additional studies are needed, our results demonstrate the feasibility of donor age restriction for LT recipients with HCV, and such information may be relevant to programs with limited access to new antiviral therapies for which modifying the risk of severe disease remains of paramount importance.
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U2 - 10.1002/lt.23937
DO - 10.1002/lt.23937
M3 - Article
C2 - 24961679
AN - SCOPUS:84908504819
SN - 1527-6465
VL - 20
SP - 1202
EP - 1210
JO - Liver Transplantation
JF - Liver Transplantation
IS - 10
ER -