Study shows using expanded critera donors is safe

Patients who had received livers from hepatitis B virus core antibody (HBcAb) positive (indicates prior exposure to hepatitis B) and/or hepatitis C virus (HCV) positive donors had similar graft and patient survival compared to patients who received HBcAb negative or HCV negative livers, according to a study by the University of Pittsburgh's Thomas E. Starzl Transplantation Institute.

The results of their findings are being presented today at sixth annual American Transplant Congress, the joint scientific meeting of the American Society of Transplant Surgeons and the American Society of Transplantation at the Washington State Convention & Trade Center in Seattle.

To help alleviate the shortage of organs, there has been an increase in the transplantation of livers obtained from extended criteria donors, such as organs from HBcAb positive and HCV positive donors. In the Pitt study, the researchers conducted a seven-year review of liver transplant recipients who received HBV positive and HCV positive organs between 1997 and 2004. The patients were divided into three groups. Group one consisted of 28 patients that received both HBcAb positive and HCV positive livers; the second group consisted of 58 patients that received HBcAb positive livers; and the third group consisted of 34 patients that received HCV positive livers. Patient and graft survival and recurrence of the HBV and HCV infections were compared between the various groups of patients.

Treatment to prevent recurrent HBV infection consisted of hepatitis B immune globulin and/or lamivudine for groups one and two. The mean follow up for all patients was two years and there were no significant differences between recipients of all groups with respect to age, sex and MELD scores – a liver transplant scoring system which estimates a patient's risk of dying while waiting for the transplant.

Patient and graft survival were the following: Group one, 68 percent and 64 percent respectively; Group two, 76 percent and 65 percent respectively; Group three, 82 percent and 76 percent respectively. Overall, recurrent HBV post-transplantation occurred in four out of 86 patients and no grafts were lost to HBV recurrence. Of those patients who received HCV positive livers, 15 of 62 patients who received HCV positive grafts have died; two deaths were due to HCV graft failure and another two were HCV related. One patient has been re-transplanted for recurrent HCV cirrhosis. While HCV recurrence in groups one and three were universal, the severity of recurrence and response to interferon-based therapy was comparable to HCV patients who received HCV negative livers.

Michael E. de Vera, M.D., assistant professor of surgery at the University of Pittsburgh's Thomas E. Starzl Transplantation Institute and lead author of the study, concluded based on these research findings that the use of HBV and/or HCV positive livers for organ donation is safe. HBV recurrence is minimal with the use of HBV prophylaxis and HCV recurrence is similar to that of HCV patients who receive HCV negative livers.

"These findings substantiate the practice of transplanting HBcAb positive and/or HCV positive livers. When selected properly for transplantation, these organs are often of good quality, and so long as they are transplanted to the appropriate recipients, long-term results are comparable to patients who receive livers from HBV- or HCV-negative donors. The use of these livers significantly increases the number of organs available for transplantation," according to Amadeo Marcos, M.D., chief, clinical transplantation at the University of Pittsburgh's Thomas E. Starzl Transplantation Institute.