LONG-TERM OUTCOME OF PATIENTS TRANSPLANTED WITH LIVERS FROM HEPATITISC-POSITIVE DONORS

Background. The use of hepatitis C serology-positive donors has become an option in patients affected by hepatitis C (Hep C) end-stage liver disease. Previous studies with less than 1 year of follow-up have sug gested that there is no difference in early patient and graft survival . The aim of our review is to confirm with a longer follow-up (a minim um of 1 year) that the use of these organs is safe and that patient an d graft survival are comparable to those of patients with Hep C who re ceived Hep C-negative grafts. Methods. Between 1985 and 1995, 213 pati ents were transplanted with a diagnosis of Hep C, Seventy-six patients were excluded from the study, 47 for insufficient follow-up and 29 be cause the diagnosis of recurrence was not certain. Twenty-two patients received Hep C+ donor grafts and 115 patients received Hep C- donor g rafts. These two groups were evaluated to assess the rate and severity of recurrence by serial biopsies and to assess patient and graft surv ival. Results. Recurrent Hep C was documented by biopsy in 12 of 22 pa tients who received Hep C+ donor grafts. Of these 12 patients, 9 had m ild chronic hepatitis, 2 had fibrosis, and 1 had cirrhosis. Ten of the 22 patients had normal biopsies. Of the patients who received Hep C- grafts, 48 of 115 had recurrent disease. Of these 48 patients, 23 had mild chronic hepatitis, 15 had fibrosis, and 10 had cirrhosis. Sixty-s even of 115 had normal biopsies. The recurrence rate was 54.55% in the Hep C+ donor grafts and 41.74% in the Hep C-donor grafts (P=NS), Pati ent and graft survival at 4 years after transplant were 83.9% and 71.9 % in the Hep C+ donor grafts and 79.1% and 76.2% in the Hep C- donor g rafts, respectively (P=NS). Conclusions. Our study suggests that Hep C + donors can be used with excellent long-term results and that the pro gression of the recurrent disease does not seem to be affected by the pre-existence of the Hep C virus in the donor.