Hepatitis C disease severity in living versus deceased donor liver transplant recipients: an extended observation study
| Autor: | Terrault, Norah A, Stravitz, R Todd, Lok, Anna SF, Everson, Greg T, Brown, Robert S, Kulik, Laura M, Olthoff, Kim M, Saab, Sammy, Adeyi, Ovedele, Argo, Curtis K, Everhart, Jay E, Rodrigo, Del R, A2ALL Study Group |
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| Rok vydání: | 2014 |
| Předmět: |
Graft Rejection
Adult Male Time Factors A2ALL Study Group Chronic Liver Disease and Cirrhosis Clinical Sciences Immunology Medical Biochemistry and Metabolomics Severity of Illness Index Risk Assessment Hepatitis Hepatitis - C Risk Factors Clinical Research Living Donors Humans Prospective Studies Retrospective Studies Transplantation Gastroenterology & Hepatology Liver Disease Organ Transplantation Middle Aged Hepatitis C Tissue Donors Liver Transplantation Treatment Outcome Emerging Infectious Diseases Infectious Diseases Good Health and Well Being Disease Progression Female Digestive Diseases Follow-Up Studies |
| Zdroj: | Hepatology (Baltimore, Md.), vol 59, iss 4 |
| Popis: | UnlabelledDonor factors influence hepatitis C virus (HCV) disease severity in liver transplant (LT) recipients. Living donors, because they are typically young and have short cold ischemic times, may be advantageous for HCV-infected patients. Among HCV-infected patients in the Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL) surviving >90 days and followed for a median 4.7 years, advanced fibrosis (Ishak stage ≥3) and graft loss were determined. The 5-year cumulative risk of advanced fibrosis was 44% and 37% in living donor LT (LDLT) and deceased donor LT (DDLT) patients (P = 0.16), respectively. Aspartate aminotransferase (AST) activity at LT (hazard ratio [HR] = 1.38 for doubling of AST, P = 0.005) and biliary strictures (HR = 2.68, P = 0.0001) were associated with advanced fibrosis, but LDLT was not (HR = 1.11, 95% confidence interval [CI] 0.73-1.69, P = 0.63). The 5-year unadjusted patient and graft survival probabilities were 79% and 78% in LDLT, and 77% and 75% in DDLT (P = 0.43 and 0.32), with 27% and 20% of LDLT and DDLT graft losses due to HCV (P = 0.45). Biliary strictures (HR = 2.25, P = 0.0006), creatinine at LT (HR = 1.74 for doubling of creatinine, P = 0.0004), and AST at LT (HR = 1.36 for doubling of AST, P = 0.004) were associated with graft loss, but LDLT was not (HR = 0.76, 95% CI: 0.49-1.18, P = 0.23).ConclusionDonor type does not affect the probability of advanced fibrosis or patient and graft survival in HCV-infected recipients. Thus, while LDLT offers the advantage of shorter wait times, there is no apparent benefit for HCV disease progression. Biliary strictures have a negative effect on HCV fibrosis severity and graft survival, and a high AST at LT may be an important predictor of fibrosis risk post-LT. |
| Databáze: | OpenAIRE |
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