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• W1480496035 abstract "To the Editor: We read with great interest the study by Ghinolfi et al (1.Ghinolfi D Marti J De Simone Use of octogenarian donors for liver transplantation: A survival analysis.Am J Transplant. 2014; 14 (et al): 2062-2071Abstract Full Text Full Text PDF PubMed Scopus (81) Google Scholar) recently published in American Journal of Transplantation. In this report, 5-year patient and graft survival rates with donors ≥80 years were outstanding—78.2% and 77.1%, respectively. Hepatitis C virus (HCV) status was the most significant factor of graft survival at multivariate analysis (hazard ratio 1.749, p < 0.001). At the latest follow-up, clinically significant HCV recurrence was observed in 13.6% and 9% of the patients transplanted with donors between 70 and 79 years of age and ≥80 years, respectively; comparable to that observed with younger donors. Of note, 5-year graft survival of the HCV-positive recipients transplanted with donors ≥80 years was 62.4% which, albeit significantly lower than that of the non-HCV recipients, is surprisingly high. Unfortunately, information on late graft loss and late retransplantation is not provided by the authors. Our experience is different. In November 2009, our IRB approved a retrospective case–control study to compare a study group of 25 HCV-positive patients transplanted between January 1998 and October 2004 with donors ≥70 years with a control group of 50 patients transplanted with donors <70 years during the same period of time (2.Gastaca M Ruiz P Fernandez JR Long-term outcome of liver transplantation with donors aged 70 and above in HCV patients. A case control study.Liver Transplant. 2010; 16 (et al): S127Google Scholar). All recipients had a minimum follow-up of 5 years. An aggressive HCV recurrence, defined as cholestatic or fibrosis stage ≥2 according to Scheuer score within the first year, was assessed in 75% of patients in the study group versus 33.3% in the control group (p = 0.002). Survival at 1, 5, 7, and 10 years in the study and control groups was as follows: graft survival was 84%, 48%, 29.1%, and 29.1% versus 100%, 82%, 74%, and 57%, respectively (p < 0.008), while patient survival was 84%, 63.7%, 51.8%, and 51.8% versus 100%, 82%, 74%, and 62.8%, respectively (p = n.s.). Of note, the rate of retransplantation was 25% versus 2% in the study and control groups (p = 0.004), all due to HCV recurrence. Similar results were recently published with 50% and 40% 5-year patient and graft survival in HCV-positive recipients transplanted with donors older than 70 years (3.Cherid FM Rosen CB Nyberg SL Heimbach JK Excellent long-term patient and graft survival are possible with appropriate use of livers from deceased septuagenarian and octogenarian donors.HPB (Oxford). 2014; 16: 852-858Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar). The reasons for the positive results obtained by Ghinolfi et al are difficult to determine. The mean Model for End-Stage Liver Disease score of our study group was 15 ± 6.4 and our aged donors were also carefully selected with significantly less hypotension episodes, lower mean alanine aminotransferase and a mean cold ischemic time of 290 ± 65 min. Nevertheless, the fact that our patients were transplanted in an earlier period of time and the inclusion of HCV recipients with preemptive antiviral treatment in their study might account for the relative superiority of their results. For the last decade, our policy has been to avoid the use of older donors in patients with HCV owing to a prohibitively high rate of recurrence leading to graft loss and retransplantation; however, this policy will have to be revised in the near future when the new, highly effective, HCV antiviral therapies become widely available (4.Lens S Gambato M Londono MC Forns X Interferon-free regimens in the liver-transplant setting.Semin Liver Dis. 2014; 34: 58-71Crossref PubMed Scopus (28) Google Scholar). The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation." @default.
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• W1480496035 date "2015-02-01" @default.
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• W1480496035 title "Liver Transplantation With Aged Donors in Patients With Hepatitis C Virus" @default.
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