Survival after liver transplantation using hepatitis C virus-positive donor allografts: Case-controlled analysis of the UNOS database

Background: Numerous reports have documented reduced graft and patient survival after use of hepatitis C (HCV) seropositive allografts in liver transplantation (OLT). We aimed to examine if the use of a HCV+ liver allograft affects patient and graft survivals compared to HCV- donor allografts in a case-controlled analysis of the united network for organ sharing (UNOS) database. Methods: We examined 63,149 liver transplants (61,905 donors HCV-; 1,244 donors HCV+) from the UNOS standard transplant analysis and research (STAR) file from 1987 to 2007. Donor and recipient demographics and outcomes were collected in which donor HCV serology was complete. A case-controlled cohort from 11 donor and recipient variables comparing donor HCV- and HCV+ allografts (n = 540 in each group) was created using propensity scores with a matching algorithm. Graft and patient survival was estimated using Kaplan-Meier survival curves. Results: Significant differences were evident in the unadjusted cohort between recipients who received HCV+ and HCV- allografts, including HCV+ recipients, donor and recipient age, and model for end-stage liver disease (MELD) exception cases. Use of HCV+ allograft resulted in significantly lower graft survival (8.1 vs. 10.6 years; P = 0.001) and patient survival (10.2 vs. 12.3 years; P = 0.01) after OLT. In the matched cohort, HCV seropositivity had no detrimental effect on the graft (P = 0.57) or patient (P = 0.78) survival after OLT. Conclusions: This is the first population-based analysis to show that after adjusting for donor and recipient characteristics there was no difference in graft or patient survival with the use of HCV+ donor liver allografts compared to HCV- donor liver allografts.