Risk of advanced fibrosis with grafts from hepatitis C antibody-positive donors

A multicenter cohort study

Jennifer C. Lai, Jacqueline G. O'Leary, James F. Trotter, Elizabeth C. Verna, Robert S. Brown, R. Todd Stravitz, Jeffrey D. Duman, Lisa M. Forman, Norah A. Terrault

Research output: Contribution to journalArticle

38 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)532-538
Number of pages7
JournalLiver Transplantation
Volume18
Issue number5
DOIs
StatePublished - May 1 2012

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Hepatitis C Antibodies
Hepacivirus
Multicenter Studies
Fibrosis
Cohort Studies
Tissue Donors
Transplants

ASJC Scopus subject areas

  • Surgery
  • Hepatology
  • Transplantation

Cite this

Lai, J. C., O'Leary, J. G., Trotter, J. F., Verna, E. C., Brown, R. S., Stravitz, R. T., ... Terrault, N. A. (2012). Risk of advanced fibrosis with grafts from hepatitis C antibody-positive donors: A multicenter cohort study. Liver Transplantation, 18(5), 532-538. https://doi.org/10.1002/lt.23396

Risk of advanced fibrosis with grafts from hepatitis C antibody-positive donors : A multicenter cohort study. / Lai, Jennifer C.; O'Leary, Jacqueline G.; Trotter, James F.; Verna, Elizabeth C.; Brown, Robert S.; Stravitz, R. Todd; Duman, Jeffrey D.; Forman, Lisa M.; Terrault, Norah A.

In: Liver Transplantation, Vol. 18, No. 5, 01.05.2012, p. 532-538.

Research output: Contribution to journalArticle

Lai, JC, O'Leary, JG, Trotter, JF, Verna, EC, Brown, RS, Stravitz, RT, Duman, JD, Forman, LM & Terrault, NA 2012, 'Risk of advanced fibrosis with grafts from hepatitis C antibody-positive donors: A multicenter cohort study', Liver Transplantation, vol. 18, no. 5, pp. 532-538. https://doi.org/10.1002/lt.23396
Lai, Jennifer C. ; O'Leary, Jacqueline G. ; Trotter, James F. ; Verna, Elizabeth C. ; Brown, Robert S. ; Stravitz, R. Todd ; Duman, Jeffrey D. ; Forman, Lisa M. ; Terrault, Norah A. / Risk of advanced fibrosis with grafts from hepatitis C antibody-positive donors : A multicenter cohort study. In: Liver Transplantation. 2012 ; Vol. 18, No. 5. pp. 532-538.
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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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