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Contribution of donor age to the recent decrease in patient survival among HCV‐infected liver transplant recipients
Author(s) -
Berenguer Marina,
Prieto Martín,
Juan Fernando San,
Rayón José M.,
Martinez Fernando,
Carrasco Domingo,
Moya Angel,
Orbis Francisco,
Mir José,
Berenguer Joaquín
Publication year - 2002
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1053/jhep.2002.33993
Subject(s) - medicine , cirrhosis , immunosuppression , hepatitis c virus , gastroenterology , hepatitis c , liver transplantation , liver disease , transplantation , immunology , virus
Recurrent hepatitis occurs in the majority of patients undergoing liver transplantation for hepatitis C virus (HCV) cirrhosis, with progression to cirrhosis in up to 30% after 5 years. Based on these data, a decrease in survival can be anticipated with prolonged follow‐up. Furthermore, posttransplantation HCV‐fibrosis progression has been shown in recent years to increase. Our aims were (1) to describe the natural history of HCV‐infected recipients, particularly to determine whether survival has decreased in recent years; (2) to compare this outcome with that observed in non–HCV‐infected cirrhosis controls; and (3) to determine the factors associated with disease severity and survival. Among 522 cirrhotic patients undergoing transplantation between 1991 and 2000, 283 (54%) were infected with HCV. Yearly biopsies were performed in these recipients and at 1 and 5 years in the remainder. With similar follow‐up, the percentage of deaths in the HCV(+) group was significantly higher than in the HCV(−) group (37% vs. 22%, P < .001), and patient survival was lower (77%, 61%, 55% vs. 87%, 76%, 70% at 1, 5, and 7 years, respectively; P = .0001). Although survival has increased in the HCV(−) group in recent years, it has significantly decreased in HCV recipients ( P < .0001). The main cause of death among the latter was decompensated graft cirrhosis (n = 23/105, 22%), whereas that of HCV(−) patients was infections (n = 10/52, 19%). Reasons for the recent worse outcome in HCV(+) recipients include the increased donor age and stronger immunosuppression. In conclusion, patient survival is lower among HCV(+) recipients than among HCV(−) ones and has been decreasing in recent years. The aging of donors is a major contributor to this worse outcome.