OUTCOMES OF LIVER TRANSPLANTATION I

R. Ballarin¹, G. Tarantino¹, A. Cucchetti², M. Spaggiari¹, R. Montalti¹, F. Di benedetto¹, M. Valmasoni³, C. Longo⁴, N. De ruvo¹, N. Cautero¹, G.P. Guerrini¹, S. Nadalin⁵, R. Troisi⁶, U. Cillo³, A.D. Pinna², P. Burra⁷, G.E. Gerunda^1
1Liver And Multivisceral Transplant Center, UNIVERSITY OF MODENA AND REGGIO EMILIA, MODENA/ITALY, ²Department Of Liver And Multi-organ Transplantation, Sant 'orsola-malpighi Hospital, University of Bologna, Bologna/ITALY, ³Surgery Section, Department Of Surgical And Gastroenterological Sciences, University of Padova, Padova/ITALY, ⁴Department Of Gastrointestinal & Surgical Sciences, Clinica Chirurgica Iii, University of Padova, Padova/ITALY, ⁵Department Of General Surgery And Transplantation, University of Tüebingen, Tüebingen/GERMANY, ⁶Department Of General Surgery, Hepato-biliary And Liver Transplantation Service, Ghent University Hospital Medical School, Ghent/BELGIUM, ⁷Gastroenterology Section, Department Of Surgical And Gastroenterological Sciences, University of Padova, Padova/ITALY

Body: Introduction: The growing prevalence of hepatitis C virus infection in the general population has resulted in an increased frequency of potential organ donors that carry the virus. Given the significant disparity between organ supply and demand for transplantation, it becomes essential to consider whether livers from HCV positive donors may be considered suitable for transplantation. Few reports, with very limited series, have examined the complete virological status in HCV positive donors (HCV RNA positive or nonviremic) and the interactions between different viral strains after liver transplantation. Preliminary reports have been published with short follow-ups and no differences in outcomes with the use of HCV positive grafts. However, these results might be affected by the very small sample sizes and may be biased by the limited number of centers. Methods: Based on a multicenter European database, we used pair-wise matched analysis to establish whether one could safely expand the donor pool by using livers from HCV positive donors. Patients transplanted between February 18, 1999 and March 14, 2009 were retrospectively evaluated. The goal was to determine the role of hepatitis C serology of the donor on patient and graft survival and the timing and severity of HCV recurrence. Finally, we examined the genetic dynamics of HCV in the setting of liver transplantation in which both donors and recipients were infected with different HCV strains. Results: Among 694 patients with HCV-related cirrhosis who underwent liver transplantation during the study period, 11% received the graft from HCV positive donors. HCV RNA was positive in 27 donors (42.9%), while 36 (57.1%) were HCV RNA negative. The mean follow-up for the cohort of HCV positive recipients of HCV positive grafts was 37.4 months whereas it was 42.9 months in HCV positive recipients of HCV negative donor grafts. In comparing overall patient and graft survival there was no statistically significant difference between the two groups (p=0.36 and 0.14). Recurrence of HCV was more rapid in the group of patients who received HCV positive grafts (p=0.07). This difference becomes even more significant when we consider only the group receiving HCV RNA positive grafts (p= <0.01). The HAI inflammatory grade was greater at the time of HCV recurrence in the group of patients who received HCV positive grafts (6 ± 2.13) compared with the control group (4.79 ± 1.72) and this difference was statistically significant (p = 0.004). The fibrosis stage was also greater at the time of HCV recurrence in the group of patients who received HCV positive grafts (1.94 ± 0.93) compared with the control group (1.5 ± 0.71) and this difference was statistically significant (p = 0.015). Conclusion: In summary, we studied the clinical implication of HCV superinfection in the setting of liver transplantation and we found that HCV positive grafts represent a significant risk factor for earlier HCV recurrence, mainly in the presence of HCV RNA positivity in the donor serum and irrespective of the donor and recipient genotype.

Disclosure: All authors have declared no conflicts of interest.