Hepatitis C virus recurrence occurs earlier in patients receiving donation after circulatory death liver transplant grafts compared with those receiving donation after brainstem death grafts

S A Townsend; M A Monga; P Nightingale; D Mutimer; A M Elsharkawy; A Holt; David Mutimer

doi:10.1016/j.transproceed.2017.07.016

Hepatitis C virus recurrence occurs earlier in patients receiving donation after circulatory death liver transplant grafts compared with those receiving donation after brainstem death grafts

S A Townsend, M A Monga, P Nightingale, D Mutimer, A M Elsharkawy, A Holt, David Mutimer

Immunology and Immunotherapy

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Abstract

INTRODUCTION: Hepatitis C virus (HCV)-related cirrhosis remains the commonest indication for liver transplantation worldwide, yet few studies have investigated the impact of donation after circulatory death (DCD) graft use on HCV recurrence and patient outcomes. DCD grafts have augmented the limited donor organ pool and reduced wait-list mortality, although concerns regarding graft longevity and patient outcome persist.

METHODS: This was a single-center study of all HCV + adults who underwent DCD liver transplantation between 2004 and 2014. 44 HCV+ patients received DCD grafts, and were matched with 44 HCV+ recipients of donation after brainstem death (DBD) grafts, and their outcomes examined.

RESULTS: The groups were matched for age, sex, and presence of hepatocellular carcinoma; no significant differences were found between the group's donor or recipient characteristics. Paired and unpaired analysis demonstrated that HCV recurrence was more rapid in recipients of DCD organs compared with DBD grafts (408 vs 657 days; P = .006). There were no significant differences in graft survival, patient survival, or rates of biliary complications between the cohorts despite DCD donors being 10 years older on average than those used in other published experience.

CONCLUSIONS: In an era of highly effective direct acting antiviral therapy, rapid HCV recrudescence in grafts from DCD donors should not compromise long-term morbidity or mortality. In the context of rising wait-list mortality, it is prudent to use all available sources to expand the pool of donor organs, and our data support the practice of using extended-criteria DCD grafts based on donor age. Notwithstanding that, clinicians should be aware that HCV recrudescence is more rapid in DCD recipients, and early post-transplant anti-viral therapy is indicated to prevent graft injury.

Original language	English
Pages (from-to)	2129-2134
Number of pages	6
Journal	Transplantation Proceedings
Volume	49
Issue number	9
DOIs	https://doi.org/10.1016/j.transproceed.2017.07.016
Publication status	Published - 15 Nov 2017

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Townsend, S. A., Monga, M. A., Nightingale, P., Mutimer, D., Elsharkawy, A. M., Holt, A., & Mutimer, D. (2017). Hepatitis C virus recurrence occurs earlier in patients receiving donation after circulatory death liver transplant grafts compared with those receiving donation after brainstem death grafts. Transplantation Proceedings, 49(9), 2129-2134. https://doi.org/10.1016/j.transproceed.2017.07.016

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title = "Hepatitis C virus recurrence occurs earlier in patients receiving donation after circulatory death liver transplant grafts compared with those receiving donation after brainstem death grafts",

abstract = "INTRODUCTION: Hepatitis C virus (HCV)-related cirrhosis remains the commonest indication for liver transplantation worldwide, yet few studies have investigated the impact of donation after circulatory death (DCD) graft use on HCV recurrence and patient outcomes. DCD grafts have augmented the limited donor organ pool and reduced wait-list mortality, although concerns regarding graft longevity and patient outcome persist.METHODS: This was a single-center study of all HCV + adults who underwent DCD liver transplantation between 2004 and 2014. 44 HCV+ patients received DCD grafts, and were matched with 44 HCV+ recipients of donation after brainstem death (DBD) grafts, and their outcomes examined.RESULTS: The groups were matched for age, sex, and presence of hepatocellular carcinoma; no significant differences were found between the group's donor or recipient characteristics. Paired and unpaired analysis demonstrated that HCV recurrence was more rapid in recipients of DCD organs compared with DBD grafts (408 vs 657 days; P = .006). There were no significant differences in graft survival, patient survival, or rates of biliary complications between the cohorts despite DCD donors being 10 years older on average than those used in other published experience.CONCLUSIONS: In an era of highly effective direct acting antiviral therapy, rapid HCV recrudescence in grafts from DCD donors should not compromise long-term morbidity or mortality. In the context of rising wait-list mortality, it is prudent to use all available sources to expand the pool of donor organs, and our data support the practice of using extended-criteria DCD grafts based on donor age. Notwithstanding that, clinicians should be aware that HCV recrudescence is more rapid in DCD recipients, and early post-transplant anti-viral therapy is indicated to prevent graft injury.",

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doi = "10.1016/j.transproceed.2017.07.016",

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Townsend, SA, Monga, MA, Nightingale, P, Mutimer, D, Elsharkawy, AM, Holt, A & Mutimer, D 2017, 'Hepatitis C virus recurrence occurs earlier in patients receiving donation after circulatory death liver transplant grafts compared with those receiving donation after brainstem death grafts', Transplantation Proceedings, vol. 49, no. 9, pp. 2129-2134. https://doi.org/10.1016/j.transproceed.2017.07.016

Hepatitis C virus recurrence occurs earlier in patients receiving donation after circulatory death liver transplant grafts compared with those receiving donation after brainstem death grafts. / Townsend, S A; Monga, M A; Nightingale, P et al.
In: Transplantation Proceedings, Vol. 49, No. 9, 15.11.2017, p. 2129-2134.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Hepatitis C virus recurrence occurs earlier in patients receiving donation after circulatory death liver transplant grafts compared with those receiving donation after brainstem death grafts

AU - Townsend, S A

AU - Monga, M A

AU - Nightingale, P

AU - Mutimer, D

AU - Elsharkawy, A M

AU - Holt, A

AU - Mutimer, David

PY - 2017/11/15

Y1 - 2017/11/15

N2 - INTRODUCTION: Hepatitis C virus (HCV)-related cirrhosis remains the commonest indication for liver transplantation worldwide, yet few studies have investigated the impact of donation after circulatory death (DCD) graft use on HCV recurrence and patient outcomes. DCD grafts have augmented the limited donor organ pool and reduced wait-list mortality, although concerns regarding graft longevity and patient outcome persist.METHODS: This was a single-center study of all HCV + adults who underwent DCD liver transplantation between 2004 and 2014. 44 HCV+ patients received DCD grafts, and were matched with 44 HCV+ recipients of donation after brainstem death (DBD) grafts, and their outcomes examined.RESULTS: The groups were matched for age, sex, and presence of hepatocellular carcinoma; no significant differences were found between the group's donor or recipient characteristics. Paired and unpaired analysis demonstrated that HCV recurrence was more rapid in recipients of DCD organs compared with DBD grafts (408 vs 657 days; P = .006). There were no significant differences in graft survival, patient survival, or rates of biliary complications between the cohorts despite DCD donors being 10 years older on average than those used in other published experience.CONCLUSIONS: In an era of highly effective direct acting antiviral therapy, rapid HCV recrudescence in grafts from DCD donors should not compromise long-term morbidity or mortality. In the context of rising wait-list mortality, it is prudent to use all available sources to expand the pool of donor organs, and our data support the practice of using extended-criteria DCD grafts based on donor age. Notwithstanding that, clinicians should be aware that HCV recrudescence is more rapid in DCD recipients, and early post-transplant anti-viral therapy is indicated to prevent graft injury.

AB - INTRODUCTION: Hepatitis C virus (HCV)-related cirrhosis remains the commonest indication for liver transplantation worldwide, yet few studies have investigated the impact of donation after circulatory death (DCD) graft use on HCV recurrence and patient outcomes. DCD grafts have augmented the limited donor organ pool and reduced wait-list mortality, although concerns regarding graft longevity and patient outcome persist.METHODS: This was a single-center study of all HCV + adults who underwent DCD liver transplantation between 2004 and 2014. 44 HCV+ patients received DCD grafts, and were matched with 44 HCV+ recipients of donation after brainstem death (DBD) grafts, and their outcomes examined.RESULTS: The groups were matched for age, sex, and presence of hepatocellular carcinoma; no significant differences were found between the group's donor or recipient characteristics. Paired and unpaired analysis demonstrated that HCV recurrence was more rapid in recipients of DCD organs compared with DBD grafts (408 vs 657 days; P = .006). There were no significant differences in graft survival, patient survival, or rates of biliary complications between the cohorts despite DCD donors being 10 years older on average than those used in other published experience.CONCLUSIONS: In an era of highly effective direct acting antiviral therapy, rapid HCV recrudescence in grafts from DCD donors should not compromise long-term morbidity or mortality. In the context of rising wait-list mortality, it is prudent to use all available sources to expand the pool of donor organs, and our data support the practice of using extended-criteria DCD grafts based on donor age. Notwithstanding that, clinicians should be aware that HCV recrudescence is more rapid in DCD recipients, and early post-transplant anti-viral therapy is indicated to prevent graft injury.

U2 - 10.1016/j.transproceed.2017.07.016

DO - 10.1016/j.transproceed.2017.07.016

M3 - Article

C2 - 29149973

SN - 0041-1345

VL - 49

SP - 2129

EP - 2134

JO - Transplantation Proceedings

JF - Transplantation Proceedings

IS - 9

ER -

Hepatitis C virus recurrence occurs earlier in patients receiving donation after circulatory death liver transplant grafts compared with those receiving donation after brainstem death grafts

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