Selection of liver graft from HCV-positive donor and prognosis of liver transplant recipients

Objective: To evaluate the feasibility and safety of using liver grafts from hepatitis C viral (HCV)-positive donors for transplant, and to provide practical and theoretical considerations of using the HCV-positive grafts. Methods: Sixty-five patients were transplanted with diagnosis of HCV-related liver diseases between 2011 and 2013, and 58 of them were enrolled in the present study. All grafts were procured from donors after cardiac death with informed consent. We compared the time of survival between patients received HCV-positive and HCV-negative donor grafts. Pathological examination was performed on liver tissues collected during operation and liver biopsy samples were collected during follow-up. Results: Twelve patients received HCV-positive donor grafts (HCV+group), and 46 received the HCV-negative donor grafts (HCV-group). Pathological examination showed that the HCV-positive donor grafts had higher inflammatory grade and fibrosis stage than the HCV-negative donor grafts. One of the donor grafts had fibrosis at S3, and primary graft non-function was observed after liver transplantation. There were no significant differences in survival time at year 1 and at year 3 post-surgery between HCV+ and HCV-groups. The HCV+ group had higher inflammatory grade and fibrosis stage than HCV-group during follow-up period (inflammatory grade: 3.0 +/- 1.4 vs. 2.6 +/- 1.5, P=0.49; fibrosis stage: 2.3 +/- 1.5 vs. 1.2 +/- 1.1, P=0.04), of which the differences in fibrosis stage was statistically significant. However, when the progression in inflammatory/fibrosis was adjusted to the baseline, there were no significant differences between the HCV+ and HCV-groups. We also assessed liver function at year 1 post-surgery. There were no significant differences in ALB (P=0.49), TBIL (P=0.71), and INR (P=0.26) between HCV+ and HCV-groups, but higher ALT (P=0.04) and AST (P=0.02) levels were found in HCV+ group. The assessment of kidney function showed that creatinine levels increased when compared to the baseline in both HCV+ and HCV-groups, although the increase was not statistically significant. Conclusion: Recipients of liver transplant had similar survival time and fibrosis progression regardless of HCV status of the donors. The HCV-positive grafts could be used for transplantation in patients with HCV-related liver disease, but detailed assessment of the liver donor is needed. Donors with no fibrosis or mild fibrosis (F <= stage 1) provide better graft survival. Donor graft with fibrosis (F=2) may still be used for patients with good liver function and low MELD score before surgery. Donor grafts with advanced stage of fibrosis (F >= stage 3) should be excluded.