Hepatitis C disease severity in living versus deceased donor liver transplant recipients: An extended observation study

Donor factors influence hepatitis C virus (HCV) disease severity in liver transplant (LT) recipients. Living donors, because they are typically young and have short cold ischemic times, may be advantageous for HCV-infected patients. Among HCV-infected patients in the Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL) surviving >90 days and followed for a median 4.7 years, advanced fibrosis (Ishak stage ≥3) and graft loss were determined. The 5-year cumulative risk of advanced fibrosis was 44% and 37% in living donor LT (LDLT) and deceased donor LT (DDLT) patients (P=0.16), respectively. Aspartate aminotransferase (AST) activity at LT (hazard ratio [HR]=1.38 for doubling of AST, P=0.005) and biliary strictures (HR=2.68, P=0.0001) were associated with advanced fibrosis, but LDLT was not (HR=1.11, 95% confidence interval [CI] 0.73-1.69, P=0.63). The 5-year unadjusted patient and graft survival probabilities were 79% and 78% in LDLT, and 77% and 75% in DDLT (P=0.43 and 0.32), with 27% and 20% of LDLT and DDLT graft losses due to HCV (P=0.45). Biliary strictures (HR=2.25, P=0.0006), creatinine at LT (HR=1.74 for doubling of creatinine, P=0.0004), and AST at LT (HR=1.36 for doubling of AST, P=0.004) were associated with graft loss, but LDLT was not (HR=0.76, 95% CI: 0.49-1.18, P=0.23). Conclusion: Donor type does not affect the probability of advanced fibrosis or patient and graft survival in HCV-infected recipients. Thus, while LDLT offers the advantage of shorter wait times, there is no apparent benefit for HCV disease progression. Biliary strictures have a negative effect on HCV fibrosis severity and graft survival, and a high AST at LT may be an important predictor of fibrosis risk post-LT.