The impact of hepatitis C virus direct acting agents in liver transplant using very old donor grafts: a real-world single-center analysis

• Published in: Updates in surgery 2022-04, Vol.74 (2), p.557-570
• Main Authors: Ghinolfi, Davide, Lai, Quirino, Carrai, Paola, Petruccelli, Stefania, Morelli, Marta, Melandro, Fabio, Biancofiore, Giandomenico, De Simone, Paolo
• Format: Article
• Language: English
• Subjects: Antiviral Agents - therapeutic use; Hepacivirus; Hepatitis C - complications; Hepatitis C - drug therapy; Hepatitis C, Chronic - complications; Hepatitis C, Chronic - drug therapy; Hepatitis C, Chronic - surgery; Humans; Liver Neoplasms - drug therapy; Liver Neoplasms - surgery; Liver Transplantation; Medicine; Medicine & Public Health; Original Article; Retrospective Studies; Surgery
• ISSN: 2038-131X; 2038-3312
• DOI: 10.1007/s13304-021-01204-2

The correct timing of use of direct acting agents (DAAs) among transplanted patients remains unknown. The aim of this paperwork is to evaluate the impact of DAAs treatment in pre- or peri-operative period in liver transplantation when grafts ≥ 70 years are used. This is a retrospective analysis comparing adult liver transplant performed for HCV-related cirrhosis and/or hepatocarcinoma using a graft ≥ 70 in the period 2015–2018 (Group DAA-HCV-OLD, study group) to three different groups: (a) anti-HCV-Ab-negative patients receiving graft ≥ 70 (no-HCV-OLD), (b) anti-HCV-Ab-negative patients receiving a graft aged 18–69 years (no-HCV-YOUNG), and (c) anti-HCV-Ab-positive patients receiving a donor graft ≥ 70 in the period 2007–2011 (no-DAA-HCV-OLD). Totally, 528 liver transplants were considered: 164 in DAA-HCV-OLD, 143 in no-HCV-OLD, 120 in no-HCV-YOUNG and 101 in no-DAA-HCV-OLD Group. Graft survival rates at 1 and 3 years were 88% and 81% in DAA-HCV-OLD Group, 82% and 68% in no-DAA-HCV-OLD ( p  = 0.007), 89% and 84% in no-HCV-OLD ( p  = 0.76), and 94% and 92% in no-HCV-YOUNG ( p  = 0.02). No differences were observed among groups in the incidence of primary non-function, primary dysfunction, vascular or biliary complications. DAAs were able to zero HCV-related graft loss, with a 3-year graft survival > 80%. The outcomes of older graft recipients became equal irrespectively of their HCV serological status.