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

Research output: Contribution to journalArticlepeer-review

Authors

  • S A Townsend
  • M A Monga
  • P Nightingale
  • D Mutimer
  • A M Elsharkawy
  • A Holt

Colleges, School and Institutes

External organisations

  • Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, United Kingdom. Electronic address: s.a.townsend@bham.ac.uk.
  • Good Hope Hospital, Rectory Road, Sutton Coldfield, Birmingham, United Kingdom.
  • FRCP Skin Oncology Service, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, United Kingdom.

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.

Details

Original languageEnglish
Pages (from-to)2129-2134
Number of pages6
JournalTransplantation Proceedings
Volume49
Issue number9
Publication statusPublished - 15 Nov 2017