Risk of Advanced Fibrosis with Grafts from Hepatitis C Antibody Positive Donors: A Multicenter Cohort Study (CRUSH-C)

摘要

Over the last decade, use of liver grafts from hepatitis C (HCV) antibody positive donors [HCV(+)D] has tripled in the U.S. Although prior studies demonstrated no association between HCV(+)D status and graft loss, the effects of HCV(+)D on histologic outcomes are not well known. HCV-infected recipients at 5 U.S. centers from 2002–2007 surviving >30 days with ≥1 post-transplant biopsy were included. Cox regression was used to examine the association between HCV(+)D status and advanced fibrosis (≥stage 3/4). Of 1,206 patients, 99 (8%) received a HCV(+)D graft. Recipients of HCV(+)D versus HCV(−)D grafts were older (p=0.03), but otherwise similar. HCV(+)D were of significantly lower quality as measured by the donor risk index (p<0.001). Advanced fibrosis occurred in 32% of HCV(+)D versus 28% of HCV(−)D graft recipients (p=0.39). Unadjusted 1- and 3-year rates of advanced fibrosis were significantly higher for HCV(+)D (14 and 48%) compared to HCV(−)D (7 and 33%) graft recipients (p=0.01). Transplantation with HCV(+)D grafts was associated with a 58% increased risk of advanced fibrosis (95% CI:1.05–2.36; p=0.03). However, in an analysis stratified at the mean donor age of 45 years, HCV(+)D status was only associated with advanced fibrosis with donors ≥45 years (HR, 1.76; 95%CI, 1.06–2.93; p=0.03) and not with donors <45 years (HR, 0.94; 95%CI:0.47–1.87; p=0.85). In conclusion, careful consideration of risk-benefit is needed with use of HCV(+)D grafts. Recipients of HCV(+)D grafts, especially from older donors, should undergo close monitoring for more rapidly progressive fibrosis. Studies are needed to determine whether early HCV therapy modifies this risk.