Artículos de revistas
Elderly Donors For Hcv+ Versus Non-hcv Recipients: Patient Survival Following Liver Transplantation
Registro en:
Transplantation Proceedings. , v. 40, n. 3, p. 792 - 796, 2008.
411345
10.1016/j.transproceed.2008.02.069
2-s2.0-42949157466
Autor
Boin I.F.S.F.
Ataide E.C.
Leonardi M.I.
Stucchi R.
Seva-Pereira T.
Pereira I.W.
Cardoso A.R.
Caruy C.A.
Luzo A.
Leonardi L.S.
Institución
Resumen
Introduction: Chronic liver failure due to hepatitis C virus (HCV)-related cirrhosis is the leading indication for liver transplantation. Inferior long-term results have been reported for liver transplantation in HCV+ patients, especially when marginal donor livers are utilized. Aim: The aim of this study was to analyze retrospectively the outcome of liver transplantation patients from elderly donors in the case of HCV+ versus non-HCV recipients. Methods: Among 330 liver transplantations performed from January 1994 to December 2006, we selected 244 excluding acute hepatic failure, children, and retransplants. Among these patients we analyzed 232 subjects who underwent the piggyback technique. Donor risk index (DRI) as described by Feng et al was applied using 1.7 as a cutoff value. We used Kaplan-Meier survival and Cox hazard regression analyses. We studied 14 donor variables using descriptive statistical tests. Results: There were 148 (63.8%) HCV+ recipients and 84 (36.2%) non-HCV liver transplant recipients. Among HCV+ recipients, 130/148 (87.8%) patients received livers, from donors less than 50 years old, and 18/148 (12.2%), over 50 years. The descriptive statistics of patient categorical variables are shown in Table 1, and continuous variables in Table 2. The cumulative proportional survival curves are shown in Figs 1 and 2. Mortality predictive factors in HCV+ liver transplant recipients with donor age > 50 years old as determined by Cox hazard regression showed that death risk was increased with hazard ratios for warm ischemia = 1.01 (P = .001); for red blood cell intraoperative requirements = 2.63 (P = .003); for Child-Turcotte-Pugh classification points = 2.25 (P = .04), and for DRI > 1.7 = 2.19 (P = .03). In conclusion, advancing donor age, as well as the use of nonideal donors, intraoperative bleeding, and prolonged warm ischemia, had an adverse influence on patient survival for HCV+ recipients. © 2008 Elsevier Inc. All rights reserved. 40 3 792 796 Adam, R., McMaster, P., O'Grady, J.G., Evolution of liver transplantation in Europe: report of the European Liver Transplant Registry (2003) Liver Transpl, 9, p. 1231 Berenguer, M., Lopez-Labrador, F.X., Wright, T.L., Hepatitis C and liver transplantation (2001) J Hepatol, 35, p. 666 Wiesner, R.H., Sorrell, M., Villamil, F., Report of the first International Liver Transplantation Society expert panel consensus conference on liver transplantation and hepatitis C (2003) Liver Transpl, 9 (SUPPL), pp. S1 Prieto, M., Berenguer, M., Rayon, J.M., High incidence of allograft cirrhosis in hepatitis C virus genotype 1b infection following transplantation: relationship with rejection episodes (1999) Hepatology, 29, p. 250 Gane, E.J., Portmann, B.C., Naoumov, N.V., Long-term outcome of hepatitis C infection after liver transplantation (1996) N Engl J Med, 334, p. 815 Feray, C., Caccamo, L., Alexander, G.J., European collaborative study on factors influencing outcome after liver transplantation for hepatitis C. European Concerted Action on Viral Hepatitis (EUROHEP) Group (1999) Gastroenterology, 117, p. 619 Forman, L.M., Lewis, J.D., Berlin, J.A., The association between hepatitis C infection and survival after orthotopic liver transplantation (2002) Gastroenterology, 122, p. 889 Berenguer, M., Prieto, M., San Juan, F., Contribution of donor age to the recent decrease in patient survival among HCV-infected liver transplant recipients (2002) Hepatology, 36, p. 202 Futagawa, Y., Terasaki, P.I., Waki, K., No improvement in long-term liver transplant graft survival in the last decade: an analysis of the UNOS data (2006) Am J Transplant, 6, p. 1398 Berenguer, M., Ferrell, L., Watson, J., HCV-related fibrosis progression following liver transplantation: increase in recent years (2000) J Hepatol, 32, p. 673 Rodriguez-Luna, H., Douglas, D.D., Natural history of hepatitis C following liver transplantation (2004) Curr Opin Infect Dis, 17, p. 363 Roche, B., Samuel, D., Aspects of hepatitis C virus infection relating to liver transplantation (2006) Eur J Gastroenterol Hepatol, 18, p. 313 Busquets, J., Xiol, X., Figueras, J., The impact of donor age on liver transplantation: influence of donor age on early liver function and on subsequent patient and graft survival (2001) Transplantation, 71, p. 1765 Pirenne, J., Declauwe, H., Aerts, R., Patients transplanted for hepatitis C should not receive organs from older donors (2001) Hepatology, 34, pp. 409A Takada, Y., Haga, H., Ito, T., Clinical outcomes of living donor liver transplantation for hepatitis C virus (HCV)-positive patients (2006) Transplantation, 81, p. 350 Feng, S., Goodrich, N.P., Bragg-Gresham, J.L., Characteristics associated with liver graft failure: the concept of a donor risk index (2006) Am J Transplant, 6, p. 783 Maluf, D.G., Edwards, E., Kauffman, H.M., Utilization of extended donor criteria liver allograft: is the elevated risk of failure independent of the model for end-stage liver disease score of the recipient? (2006) Transplantation, 82, p. 1653 Charlton, M., Recurrence of hepatitis C infection: where are we now? (2005) Liver Transpl, 11 (SUPPL. 1), pp. S57 Carmiel-Haggai, M., Fiel, M.I., Gaddipati, H.C., Recurrent hepatitis C after re-transplantation: factors affecting graft and patient outcome (2005) Liver Transpl, 11, p. 1567 Wali, M., Harrison, R.F., Gow, P.J., Advancing donor liver age and rapid fibrosis progression following transplantation for hepatitis C (2002) Gut, 51, p. 248 Machicao, V.I., Bonatti, H., Krishna, M., Donor age affects fibrosis progression and graft survival after liver transplantation for hepatitis C (2004) Transplantation, 77, p. 84 Walter, T., Dumortier, J., Guillaud, O., Factors influencing the progression of fibrosis in patients with recurrent hepatitis C after liver transplantation under antiviral therapy: a retrospective analysis of 939 liver biopsies in a single center (2007) Liver Transpl, 13, p. 294 Bueno, F.S., Ortiz, M.L., Bermejo, J., Prognostic factors for hepatitis C recurrence in patients undergoing orthotopic liver transplantation (2006) Transpl Immunol, 17, p. 47 Burak, K.W., Kremers, W.K., Batts, K.P., Impact of cytomegalovirus infection, year of transplantation, and donor age on outcomes after liver transplantation for hepatitis C (2002) Liver Transpl, 8, p. 362 Lake, J.R., Shorr, J.S., Steffen, B.J., Differential effects of donor age in liver transplant recipients infected with hepatitis B, hepatitis C and without viral hepatitis (2005) Am J Transplant, 5, p. 549 Berenguer, M., Ferrell, L., Watson, J., HCV-related fibrosis progression following liver transplantation: increase in recent years (2000) J Hepatol, 32, p. 673 Kuo, A., Terrault, N.A., Management of hepatitis C in liver transplant recipients (2006) Am J Transplant, 6, p. 449 McCluskey, A.S., Karkouti, K., Wijeysundera, D.N., Derivation of a risk index for the prediction of massive blood transfusion in liver transplantation (2006) Liver Transpl, 12, p. 1584