Abstract

BACKGROUND: Liver disease caused by hepatitis C virus (HCV) is the main indication for liver transplantation (LT) among adults in the US. Recurrent HCV impairs patient and graft survival after LT. The high prevalence of HCV along with scarce organs has lead to increased utilization of HCV+ organs. We estimated the impact of HCV+ donors on patient and graft survival.

MATERIAL AND METHODS: We conducted a cohort study of LT recipients age 18 years or older from February 2002 through December 2012 utilizing UNOS data. We evaluated differences in patient characteristics between HCV+ and HCV- recipients. We also compared patient and graft survival between these groups and among HCV+ recipients who received HCV+ versus HCV- donor organs using the Kaplan-Meier estimator and multivariate stratified Cox regression models.

RESULTS: We identified 59,899 LT recipients. Among those, 1,695 (2.8%) were HCV+ who received HCV+ grafts. HCV+ recipients of HCV- grafts were more likely to be female, hospitalized, in the ICU, on a ventilator, had higher MELD scores, and higher bilirubin. Patient and graft survival at 1, 5, and 10 years in HCV+ recipients was inferior to HCV– recipients, but HCV+ recipients who received HCV+ versus HCV– grafts were equivalent. Multivariate regression revealed multiple variables associated with worse outcomes.

CONCLUSIONS: The use of HCV+ grafts in HCV+ recipients is not associated with worse outcomes. With the increase in HCV+ patients awaiting an organ, more consideration should be given to HCV+ donors.

Keywords: Hepatitis C, Liver Transplantation, Survival