Outcomes of liver transplantation with donors older than 80 years in HCV patients treated with direct-action antivirals vs. non-HCV patients

Abstract

Background

Multiple studies have shown good results with the use of octogenarian donors in non-HCV recipients and its use is universally accepted worldwide. There are no studies analyzing differences between hepatitis C virus (HCV) and non-HCV recipients transplanted with donors ≥ 80 years in the direct-action antivirals (DAA) period. The rate of liver transplantation (LT) using old donors is still low, and a change in the acceptance of these grafts could increase the liver pool available for LT.

Material and methods

Since the introduction of DAA therapy in our hospital in January 2014 to May 2022, 457 LT were performed, and 74 (16.2%) of these patients underwent LT with donors ≥ 80 years. A cohort study was carried-out comparing 15 HCV-positive recipients vs. 59 HCV-negative patients during the period of the study.

Results

Recipients were younger in the non-HCV group. MELD and subsequently DMELD were higher in non-HCV group. Nevertheless, the association of hepatocellular carcinoma (HCC) with HCV cirrhosis was higher than with non-HCV cirrhosis (86.7% vs. 28.8%; p < 0.001), but there were no recurrences within HCV group and only 1 case in the non-HCV group. The 1-, 3-, and 5-years patient and graft survival were similar in both groups. Recipient age and intraoperative transfusion requirements were predictors of graft survival [(HR 1.10, 95CI 1.01–1.21; p = 0.03) and (HR 1.03, 95CI 1.01–1.05; p < 0.001), respectively].

Conclusions

In conclusion, the use of octogenarian donors was a safe alternative to younger donors in HCV recipients requiring LT in the era of DAA with similar results to those obtained in non-HCV patients.