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Contribution of donor age to the recent decrease in patient survival among HCV-infected liver transplant recipients.

Marina Berenguer·Martín Prieto·Fernando San Juan·José M Rayón·Fernando Martinez·Domingo Carrasco·Angel Moya·Francisco Orbis·José Mir·Joaquín Berenguer
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Abstract

Recurrent hepatitis occurs in the majority of patients undergoing liver transplantation for hepatitis C virus (HCV) cirrhosis, with progression to cirrhosis in up to 30% after 5 years. Based on these data, a decrease in survival can be anticipated with prolonged follow-up. Furthermore, posttransplantation HCV-fibrosis progression has been shown in recent years to increase. Our aims were (1) to describe the natural history of HCV-infected recipients, particularly to determine whether survival has decreased in recent years; (2) to compare this outcome with that observed in non-HCV-infected cirrhosis controls; and (3) to determine the factors associated with disease severity and survival. Among 522 cirrhotic patients undergoing transplantation between 1991 and 2000, 283 (54%) were infected with HCV. Yearly biopsies were performed in these recipients and at 1 and 5 years in the remainder. With similar follow-up, the percentage of deaths in the HCV(+) group was significantly higher than in the HCV- group (37% vs. 22%, P <.001), and patient survival was lower (77%, 61%, 55% vs. 87%, 76%, 70% at 1, 5, and 7 years, respectively; P =.0001). Although survival has increased in the HCV- group in recent years, it has significantly decreased in HCV recipients (P <.0001). The main cause of death among the latter was decompensated graft cirrhosis (n = 23/105, 22%), whereas that of HCV- patients was infections (n = 10/52, 19%). Reasons for the recent worse outcome in HCV+ recipients include the increased donor age and stronger immunosuppression. In conclusion, patient survival is lower among HCV+ recipients than among HCV- ones and has been decreasing in recent years. The aging of donors is a major contributor to this worse outcome.

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AdultAge FactorsAgedBiopsyFemaleGraft SurvivalHepatitis CHumansImmunosuppression TherapyLiverLiver CirrhosisLiver TransplantationMaleMiddle AgedRecurrenceRisk FactorsSurvival RateTissue DonorsTreatment OutcomeJournal Article

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Marina Berenguer, Martín Prieto, Fernando San Juan, José M Rayón, Fernando Martinez, Domingo Carrasco, Angel Moya, Francisco Orbis, José Mir, Joaquín Berenguer. 2002. Contribution of donor age to the recent decrease in patient survival among HCV-infected liver transplant recipients.. https://doi.org/10.1053/jhep.2002.33993

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