Clinical

HCV-infected donor livers benefit HCV-infected patients

Last Updated: 2007-05-22 16:55:45 -0400 (Reuters Health)

By Martha Kerr

WASHINGTON (Reuters Health) - Donor livers with hepatitis C virus (HCV) appear to offer a slight survival advantage over uninfected organs in patients also infected with HCV who are in need of a liver transplant.

These organs are traditionally thought to be suboptimal, because they do not meet the criteria established by the United Network for Organ Sharing (UNOS) for donor livers, so this finding should widen the pool of livers available for transplantation, investigators announced here at Digestive Disease Week 2007.

There are approximately 6000 liver transplants done in the US every year and about half are for HCV-related cirrhosis, principal investigator Dr. Paul Kwo of the Indiana University School of Medicine in Indianapolis said as he presented his team's findings of a case-control study of patients who received extended-criteria donor livers.

The investigators used data from UNOS, the transplant center registry and the on-site donor data chart to identify 38 HCV-infected recipients of HCV-infected livers. The outcomes were compared with those of 76 liver transplant recipients of donor livers meeting strict UNOS criteria.

Dr. Kwo said demographics were similar between the extended criteria group and the standard matched donor-recipients. Warm and cold ischemia times were also similar.

One-year survival rates favored recipients of HCV-infected livers at 97% compared with 1-year graft- and patient-survival rates of 86% and 87.5%, respectively, for recipients of organs meeting UNOS criteria, Dr. Kwo reported.

The 2-year graft- and patient-survival rate among recipients of HCV-infected livers was 84%. The 2-year graft- and patient-survival rate of donors or organs meeting UNOS criteria was 79% and 84%, respectively.

Significantly less fibrosis developed in HCV-infected organs at 1 year post-transplant, with a 26% increase compared with a 69% increase in scarring with UNOS-approved organs.

"Immunosuppression does not accelerate HCV infection," Dr. Kwo reported. "The survival rates are at least equivalent, but we saw a trend toward improved survival with HCV-infected organs...We think HCV-positive organs can be considered first-line therapy for HCV-positive recipients."

"HCV-infected organs are underutilized, but they are over-represented in the donor pool," Dr. Kwo told Reuters Health. The finding that HV-infected organs can be used will widen the donor pool, he added.

The excess of HCV-infected livers may be because of more traumatic deaths and high-risk behaviors seen in donors in this younger age group, session moderator Dr. John Veiling of Baylor College of Medicine in Houston, Texas, commented in an interview with Reuters Health.