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Safe use of livers from deceased donors older than 70 years in recipients with HCV cirrhosis treated with direct-action antivirals. Retrospective cohort study
- Source :
- International journal of surgery (London, England). 91
- Publication Year :
- 2021
-
Abstract
- Introduction There is controversy regarding the use of older grafts for liver transplantation (LT) in HCV-infected patients, but the introduction of direct-acting antivirals (DAA) can radically change that debate. Methods The aim of this retrospective cohort study was to evaluate outcomes of the use of liver grafts from donors older than 70 years in recipients with HCV infection who underwent pre- or post-LT treatment with DAA. We compared two groups of patients who underwent LT using livers >70 years; the groups were defined according to antiviral therapy: non-DAA therapy group (n = 62; LT between May 1996 and December 2013), and DAA therapy group (n = 31; LT between January 2014 and December 2019). Results Thirty (96.8%) patients of DAA therapy and nine (14.5%) of non-DAA therapy (21 patients underwent complete therapy with interferon-ribavirin) achieved sustained viral response (SVR). One, 3-, and 5-year patient survival were 83.9%, 67.7%, and 56.5% in the non-DAA group vs 93.5%, 88.4%, and 88.4% in the DAA group (P = 0.04); the 1-, 3-, and 5-year graft survival were 77.4%, 62.9%, and 51.6% in the non-DAA group vs. 88.6%, 83.7%, and 83.7% in the DAA group (P = 0.03). Multivariate analysis demonstrated donor female sex and DAA therapy as protective factors of graft survival. Conclusions Pre- or post-LT therapy with DAA in HCV-infected patients has achieved an almost overall SVR. The use of liver grafts >70 years in these patients treated with DAA was associated with significantly higher 5-year patient and graft survival in DAA group compared to non-DAA group. Thus, the introduction of DAA therapy has allowed the safe use of livers >70 years in HCV-positive recipients.
- Subjects :
- Adult
Liver Cirrhosis
Male
medicine.medical_specialty
Cirrhosis
Sustained Virologic Response
medicine.medical_treatment
Hepatitis C virus
Hepacivirus
Liver transplantation
medicine.disease_cause
Antiviral Agents
Donor Selection
03 medical and health sciences
0302 clinical medicine
Internal medicine
medicine
Sustained viral response
Humans
Aged
Retrospective Studies
business.industry
Therapy group
Graft Survival
Age Factors
Female sex
Retrospective cohort study
Patient survival
General Medicine
Hepatitis C, Chronic
Middle Aged
medicine.disease
Combined Modality Therapy
Tissue Donors
Liver Transplantation
Treatment Outcome
030220 oncology & carcinogenesis
030211 gastroenterology & hepatology
Surgery
Female
business
Subjects
Details
- ISSN :
- 17439159
- Volume :
- 91
- Database :
- OpenAIRE
- Journal :
- International journal of surgery (London, England)
- Accession number :
- edsair.doi.dedup.....b16a2e14acc3547644934d318f5b6a2d