Liver Transplant Outcomes Have Improved over Time for Patients with and without Hepatitis C

		SUMMARY: Patients receiving liver transplants, whether due to hepatitis C or other causes, have benefited from improved outcomes since 2003, according to a poster presented this past weekend at the 60th Annual Meeting of the American Association for the Study of Liver Diseases (AASLD) in Boston.

By Liz Highleyman

R.C. Dickson from the Mayo Clinic in Jacksonville, Florida, and colleagues evaluated graft (new liver) survival and predictors of post-transplant outcomes in patients with and without hepatitis C virus (HCV) infection before and after 2003.

The analysis included all patients undergoing a first liver transplant between February 1998 and December 2005. Patients were divided into 2 groups: 543 received transplants during Era 1 (1998 to 2002) and 585 did so during Era 2 (2003 to 2005).

Follow-up continued through May 2009. Graft survival was compared at 1, 2, and 3 years after transplantation. Donor and recipient parameters associated with graft outcomes were assessed, with donor age categorized as < 60 or > 60 years.

Results

	Graft survival improved significantly from the 1998-2002 period to the 2003-2005 period:
	1-year survival: 77.2% during Era 1 vs 84.6% during Era 2; 2-year survival: 72.4% vs 79.7%, respectively; 3-year survival: 67.4% vs 76.9%.
	Improved graft survival was seen in both patients with and without HCV.
	Survival rates for transplant recipients without hepatitis C were:
	1-year survival: 76.2% during Era 1 vs 85.6% during Era 2; 2-year survival: 72.5% vs 79.7%, respectively; 3-year survival: 69.4% vs 77.2%, respectively.
	During Era 2, graft survival was equivalent for HCV and non-HCV patients.
	Improvement over time remained significant when patients with hepatocellular carcinoma (liver cancer) were censored.
	The most significant improvement in both the HCV and non-HCV groups between Era 1 and Era 2 was seen in patients who received livers from donors aged ? 60 years (3-year graft survival 59.0% during Era 1 vs 73.9% during Era 2; P = 0.006).
	The proportion of grafts from donors ? 60 years was similar over time (31% in Era 1 vs 32% in Era 2).
	However, use of livers from older donors for recipients with HCV decreased significantly, from 36% in Era 1 to 3% in Era 2 (P < 0.001).
	During Era 2, transplant recipients were significantly older on average (55 vs 53 years) and had higher MELD scores at the time of transplantation (18 vs 16).
	During the later period, livers came from donors with a higher body mass index (28.5 vs 26.8) and were more likely to be donations after cardiac death (DCD) (8.2% vs 4.1%).
	Donor Risk index was similar over time, 1.73 during Era 1 versus 1.76 during Era 2.

Based on these findings, the researchers concluded, "Graft survival for both HCV and non HCV patients has improved significantly since 2003 and was equivalent in both groups up to 3 years."

The "preferential use" of livers from donors age 60 or older for non-HCV patients contributed to this outcome, they added.

Department of Transplantation, Mayo Clinic, Jacksonville, FL; Clarian/Indiana University, Indianapolis, IN; University of Virginia, Charlottesville, VA.

11/3/09

Reference
RC Dickson, S Pungpapong, B Taner, and others. Improving Outcomes in Liver Transplantation for HCV and Non HCV Recipients. 60th Annual Meeting of the American Association for the Study of Liver Diseases (AASLD 2009). Boston. October 30-November 1, 2009. Abstract 505.