Transplantation · 2024
Outcomes of Liver Transplantation From Hepatitis C Virus-positive DCD Donors and Its Utilization Among Centers in the United States.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Punjala Sai Rithin, Logan April J, Subramanian Jayanthan, Von Stein Lauren, Limkemann Ashley, Al-Ebrahim Musab, Black Sylvester, Schenk Austin D, Washburn William K, Singh Navdeep
Аннотация
BACKGROUND: Donation after circulatory death (DCD) or hepatitis C virus (HCV + ) liver grafts are underused among transplant centers in the United States. The study aimed to evaluate organ utilization and outcomes of liver grafts from DCD donors with HCV infection.
METHODS: National registry and local center data of all deceased donor liver transplants performed between November 2016 and December 2021 were analyzed. All transplants were divided into 4 groups: HCV - DCD, HCV - donation after brain death [DBD], HCV + DCD, and HCV + DBD. The outcome of interest was 1-y graft survival.
RESULTS: Out of 146 liver transplant centers in the United States, liver transplants were not performed from DCD donors, HCV + donors, and a combination of DCD and HCV + donors by 28.7%, 27%, and 70%-72% of centers, respectively. In multivariate analysis, increasing center acceptance ratio was associated with increased utilization of liver grafts from DCD HCV - and DCD HCV antibody-positive nucleic acid test negative donors. Nationally, 1-y graft survival of HCV - DCD liver grafts was lower compared with other groups (89% versus 92% HCV + DCD versus 93% HCV + DBD versus 92% HCV - DBD, log rank P < 0.0001). There was no difference in 1-y graft survival among groups locally.
CONCLUSIONS: Liver grafts from HCV + DCD donors have 1-y patient and graft survival comparable with DBD liver grafts from donors with or without HCV infection. These results encourage the widespread use of liver grafts from DCD and HCV + donors and standardization of practice in DCD donation to expand the donor pool without compromising short-term outcomes.
METHODS: National registry and local center data of all deceased donor liver transplants performed between November 2016 and December 2021 were analyzed. All transplants were divided into 4 groups: HCV - DCD, HCV - donation after brain death [DBD], HCV + DCD, and HCV + DBD. The outcome of interest was 1-y graft survival.
RESULTS: Out of 146 liver transplant centers in the United States, liver transplants were not performed from DCD donors, HCV + donors, and a combination of DCD and HCV + donors by 28.7%, 27%, and 70%-72% of centers, respectively. In multivariate analysis, increasing center acceptance ratio was associated with increased utilization of liver grafts from DCD HCV - and DCD HCV antibody-positive nucleic acid test negative donors. Nationally, 1-y graft survival of HCV - DCD liver grafts was lower compared with other groups (89% versus 92% HCV + DCD versus 93% HCV + DBD versus 92% HCV - DBD, log rank P < 0.0001). There was no difference in 1-y graft survival among groups locally.
CONCLUSIONS: Liver grafts from HCV + DCD donors have 1-y patient and graft survival comparable with DBD liver grafts from donors with or without HCV infection. These results encourage the widespread use of liver grafts from DCD and HCV + donors and standardization of practice in DCD donation to expand the donor pool without compromising short-term outcomes.