THE PROBLEM OF VIRAL HEPATITIS IN LIVER TRANSPLANTATION

T.R. Flohr¹, T. Hranjec², S.C. Kumer², J.B. Stokes², H. Bonatti², R.G. Sawyer², K. Brayman², T.L. Pruett³, T.M. Schmitt^4
1Surgery, University of Virginia Health System, Charlottesville/VA/UNITED STATES OF AMERICA, ²Surgery, University of Virginia, Charlottesville/VA/UNITED STATES OF AMERICA, ³Surgery, University of Minnesota, Minneapolis/MN/UNITED STATES OF AMERICA, ⁴Department Of Surgery, University of Virginia, Charlottesville/UNITED STATES OF AMERICA

Body: Introduction: High donor risk index (DRI) is associated with worse liver transplantation (LT) outcomes and older donor age is associated with worsened fibrosis progression in HCV positive recipients. Our hypothesis was high DRI, old donor age and long cold ischemia time (CIT) support higher serum HCV viral load (VL), greater increases in VL (ΔVL) and fibrosis progression post-LT. Methods: One hundred twenty-five recipients undergoing deceased donor LT between August 1998 and September 2009 at the University of Virginia for HCV-related disease were retrospectively reviewed. DRI, donor age and CIT were determined for each donor. VL was assessed at 1, 3, 4, 6, 12 months and annually. VLs and ΔVLs were grouped as either high or low based on the median for each time point assessed. Liver biopsies were evaluated at 1, 3, 6, 12 months and annually using modified Ishak scoring. Fibrosis scores were catagorized into one of three groups: stage 0, stage 1 or ≥ stage 2. Results: Median age at LT was 53 (range 43-69) years. Recipients included 105 males and 24 second LTs. Median donor age was 39 (range 11-68) years. Median CIT was 9.5 (range 1.75-18.93) hours. High and low VL groups were compared for DRI, donor age and CIT. (Table 1.) For the first 12 months, the high VL group had a higher DRI with significance at 1 month. The trend changed at 2 years. A similar trend for donor age was seen. Prior to 6 months, high ΔVL was associated with lower DRI and younger donor age. After 6 months, the trend for ΔVL changed. The fibrosis groups were also compared for DRI, donor age and CIT. (Table 2). There was a trend of higher DRI, older donor age and increased CIT associated with fibrosis, especially at 3 and 6 months, with CIT significant at 3 months. Conclusions: These results suggest that early post-LT older allografts or higher DRIs support higher VLs, however, younger allografts or lower DRIs support larger changes in VL. The lack of a stronger association between fibrosis and donor age can likely be explained with the relatively young donor age.

Disclosure: All authors have declared no conflicts of interest.