The results of this study appear in the April 2005 issue of Liver Transplantation, the official journal of the American Association for the Study of Liver Diseases (AASLD) and the International Liver Transplantation Society (ILTS). The journal is published on behalf of the societies by John Wiley & Sons, Inc. and is available online via Wiley InterScience at http://www.
Patients who undergo liver transplantation for cirrhosis due to hepatitis C are invariably re-infected with the virus after transplantation. When the disease recurs it often has a more rapid and aggressive course than in patients who have not undergone liver transplantation. Survival rates of these patients appear to be worsening during the past few years, but recent studies have shown conflicting results about whether a donor's age can be associated with a poor outcome. The current study examined the impact of donor age, immunosuppression, and other factors on short and long term survival after liver transplant, as well as fibrosis in these patients.
Led by Dimitrios N. Samonakis, of the Liver Transplantation and Hepatobiliary Unit of the Royal Free Hospital in London, the study examined 195 transplantations due to end stage cirrhosis related to hepatitis C that took place between 1989 and June 2003. The median donor age was 41.5 years and 47 patients had a donor who was 30 years old or younger. Donor age was not associated with the development of severe fibrosis, whereas patients receiving treatment with maintenance steroids and/or azathioprine tended not to develop severe fibrosis, even if later discontinued; acute hepatitis C was an independent factor associated with worse fibrosis.
"Donor age did affect survival, but only during the early critical post-operative period, but not survival after 3 months, despite having in our cohort 30 percent of donors over 50 years," the authors state. They found maintenance azathioprine to be an independent factor associated with survival advantage, overall and from 3 months. In addition, while several studies have suggested that less immunosuppression may seem to be a viable strategy in minimizing progression of hepatitis C post-transplant, the authors found the situation to be more complex. They state that "the rapid withdrawal of steroids (but also of azathioprine) prevalent in recent years, may have allowed an early reconstitution of the immune system and its exposure to a large number of HCV [hepatitis C] infected liver cells, leading to immune mediated severe liver damage and thus to more frequent and severe forms of HCV recurrence."
The authors conclude that while donor age did not influence the progression of recurrent hepatitis C, the absence of steroids and azathioprine did play a role and maintain that these associations need to be tested in a prospective randomized fashion.
Article: "Immunosuppression and Donor Age with Respect to Severity of HCV Recurrence After Liver Transplantation," Dimitrios N. Samonakis, Christos K. Triantos, Ulrich Thalheimer, Alberto Quaglia, Gioacchino Leandro, Rosângela Teixeira, George V. Papatheodoridis, Caroline A. Sabin, Nancy Rolando, Susan Davies, Amar P. Dhillon, Paul Griffiths, Vincent Emery, David W. Patch, Brian R. Davidson, Keith Rolles, Andrew K. Burroughs, Liver Transplantation; April 2005; Volume 14, Issue 4 (Published Online: March 17, 2005).