Safe use of livers from deceased donors older than 70 years in recipients with HCV cirrhosis treated with direct-action antivirals. Retrospective cohort study. (July 2021)

• Record Type: Journal Article
• Authors: Jiménez-Romero, Carlos; Justo, Iago; Marcacuzco, Alberto; García, Virginia; Manrique, Alejandro; García-Sesma, Álvaro; Calvo, Jorge; Fernández, Inmaculada; Martín-Arriscado, Cristina; Caso, Óscar
• Is Part Of: International journal of surgery. Volume 91(2021)
• Publication Date: 2021-07
• Subjects: Septuagenarian donors -- Octogenarian donors -- Liver transplantation -- Hepatitis C virus -- Older liver donors -- Direct-acting antivirals; ALT alanine aminotransferase -- AST aspartate aminotransferase -- BMI body mass index -- CI confidence interval -- CIT cold ischemia time -- DAA direct-acting antivirals -- FFP fresh frozen plasma -- HAT hepatic artery thrombosis -- HCC hepatocellular carcinoma -- HCV hepatitis C virus -- HR hazard ratio -- ICU intensive care unit -- IFN interferon -- INR international normalized ratio -- IPF initial poor function -- MELD model for end-stage liver disease -- LT liver transplantation -- PNF primary non-function -- PRBC packed red blood cells -- RBV ribavirin -- SVR sustained virologic response -- WIT warm ischemia time; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; 617.005
• DOI: 10.1016/j.ijsu.2021.105981
• Languages: English
• ISSNs: 1743-9191

Abstract

Abstract: Introduction: There is controversy regarding the use of older grafts for liver transplantation (LT) in HCV-infected patients, but the introduction of direct-acting antivirals (DAA) can radically change that debate. Methods: The aim of this retrospective cohort study was to evaluate outcomes of the use of liver grafts from donors older than 70 years in recipients with HCV infection who underwent pre- or post-LT treatment with DAA. We compared two groups of patients who underwent LT using livers >70 years; the groups were defined according to antiviral therapy: non-DAA therapy group (n = 62; LT between May 1996 and December 2013), and DAA therapy group (n = 31; LT between January 2014 and December 2019). Results: Thirty (96.8%) patients of DAA therapy and nine (14.5%) of non-DAA therapy (21 patients underwent complete therapy with interferon-ribavirin) achieved sustained viral response (SVR). One, 3-, and 5-year patient survival were 83.9%, 67.7%, and 56.5% in the non-DAA group vs 93.5%, 88.4%, and 88.4% in the DAA group (P = 0.04); the 1-, 3-, and 5-year graft survival were 77.4%, 62.9%, and 51.6% in the non-DAA group vs. 88.6%, 83.7%, and 83.7% in the DAA group (P = 0.03). Multivariate analysis demonstrated donor female sex and DAA therapy as protective factors of graft survival. Conclusions: Pre- or post-LT therapy with DAA in HCV-infected patients has achieved an almost overall SVR. The use of liver grafts >70 years in these patients treated with DAA was associated with significantly higher 5-year patient and graft survival in DAA group compared to non-DAA group. Thus, the introduction of DAA therapy has allowed the safe use of livers >70 years in HCV-positive recipients. Highlights: Pre- or post-LT therapy with DAA in HCV-infected patients has achieved an almost overall SVR. The use of liver grafts >70 years in these patients treated with DAA was associated with significantly higher 5-year patient and graft survival. The introduction of DAA therapy has allowed the safe use of livers >70 years in HCV-positive recipients.