Hepatitis C Grafts may Be Used in Orthotopic Liver Transplant
Hepatitis C (HCV)-positive liver grafts have been increasingly used in patients with decompensated liver disease from HCV because of critical shortage of available organs. Fifty-nine recipients of HCV-positive grafts were matched to patients who received HCV-negative grafts. All recipients were transplanted for HCV liver disease. Matching variables were (1) status, (2) pre-transplant creatinine, (3) recipient age, (4) donor age, (5) warm ischemia time, and (6) year of transplantation. Both unmatched and matched analyses were performed on patient survival, graft survival, and time to HCV recurrence. There was no significant statistical difference in patient, graft, or HCV recurrence-free survival between recipients of HCV-positive and HCV-negative grafts with matched and unmatched analyses (p>0.05). The 3-year estimates of HCV disease-free survival were 12% ( ± 9%) and 19% ( ± 7%) using HCV-positive and -negative grafts, respectively. The use of HCV-positive grafts in recipients with HCV does not appear to affect patient survival, graft survival, or HCV recurrence when compared with the use of HCV-negative grafts. Our results suggest that HCV-positive grafts can be used in a HCV liver transplant recipient.

We describe 59 patients who were recipients of hepatitis C (HCV)-positive grafts. Eight patients are studied in addition to 51 patients previously described by our group who received HCV-positive grafts. Longer follow-up is available for the 51 patients, and the outcomes of all 59 patients is studied using a matched analysis.

Orthotopic liver transplantation (OLT) is a definitive treatment for decompensated liver disease. Whereas the 1-year survival for patients with decompensated cirrhosis is less than 60%, orthotopic liver transplantation achieves overall 5-year survival rates of greater than 60-70%. Currently, the leading indication for liver transplantation is hepatitis C infection (HCV).

The number of available donor organs limits OLT. Since 1988, the number of individuals on the waiting list for liver transplantation has grown from 616 to just over 16 000. Although innovations such as split-liver transplants and living related donations will likely expand the donor pool, the donor shortage will likely remain critical for the foreseeable future. A number of studies have suggested that the use of an infected HCV graft does not impact on clinical outcome ( Table 1 ). Vargas et al. found no statistical difference in the HCV recurrence rate, graft survival, and patient survival in 23 patients with HCV who were transplanted using HCV-positive grafts compared with 169 patients who received HCV-negative grafts.. Similar results were found by Testa et al. who compared the clinical outcome of 22 patients who received HCV-positive grafts with 115 patients who received HCV-negative grafts. Although there was a trend towards greater recurrence in patients who received HCV-positive grafts, the results were not statistically significant. Using the United Network for Organ Sharing (UNOS) Scientific Registry, Marroquin et al. compared outcomes of 96 recipients who received HCV-positive grafts to 2827 recipients who received HCV-negative grafts. Patient survival was significantly higher in recipients of HCV-positive grafts than in recipients of HCV-negative grafts. In a separate analysis using the UNOS Scientific Registry, graft survival was similar in recipients of HCV-positive and -negative grafts. In a database of over 500 patients transplanted for HCV from a single institution, Ghobrial et al. also demonstrated no effect on patient and graft survival by the use of HCV-positive grafts.

Because of the existing shortage of organs and the increased demand by HCV-infected patients for liver transplantation, it is essential to study whether HCV-infected grafts can be safely used. The potential use of HCV-positive grafts would have public policy implications, as it will likely increase the donor pool for OLT. Using our existing institutional database, we used pair-wise matched analysis to test the hypothesis that patient and graft survival was similar between recipients of HCV-positive grafts and HCV-negative grafts.