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Pagano D, Seidida A, Tropea A, Pietrosi G, di Francesco F, Vizzini GB, Luca A, Gruttadauria S. Use of Hepatitis C-Positive Deceased Liver Donors in Response to the Organ Shortage in an Endemic Area. Ann Transplant 2017; 22:598-601. [PMID: 28983074 DOI: 10.12659/aot.905677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The region of Sicily, Italy, is witnessing a chronic organ shortage. Thus, to face this critical issue, the use of marginal donors has increased over time. An example of marginal donor expansion is the use of liver donors who are positive for the hepatitis C antibody (HCV+) for HCV+ patients requiring liver transplantation (LT). In view of new advances in HCV therapy, including direct-acting agents (DAAs) to treat HCV in the post-transplant setting, our study focused on a monocentric experience in a series of consecutive LTs performed in adult patients receiving HCV+ liver donor allografts. From 2003 to 2016 at our institute we performed 10 LT using HCV+ deceased donors. In particular, the pre-LT histological examination in 1 case showed a framework of moderate steatosis (35% microvesicular and 10% macrovesicular) with micro/macrovesicular steatosis <10% in all the other cases. A fibrous framework of 1/6 according to the Ishak score in a single case, and 2/6 in 2 cases, were highlighted, while there was no fibrosis in the other 7 cases. A picture of periportal inflammation was still detected in 4 cases, with no evidence of inflammatory lesions in the remaining cases. The patient survival was 100% at 1 and 3 years, and 85.7% at 5 years post-LT. One-, three- and five-year graft survivals were 100.0%, 88.9%, and 71.4%, respectively. Only 1 patient underwent re-LT after 2 years, because of chronic rejection. Based on our experience using HCV+ deceased liver donors with a moderate degree of fibrosis, we believe that accepting marginal donors is a feasible therapeutic option when facing a liver donor shortage.
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Affiliation(s)
- Duilio Pagano
- Abdominal Surgery and Organ Transplant Unit, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Mediterranean Institute for Transplantation and Specialization Therapies (IRCCS-ISMETT), Palermo, Italy
| | - Aurelio Seidida
- Hepatology Unit, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Mediterranean Institute for Transplantation and Specialization Therapies (IRCCS-ISMETT), Palermo, Italy
| | - Alessandro Tropea
- Abdominal Surgery and Organ Transplant Unit, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Mediterranean Institute for Transplantation and Specialization Therapies (IRCCS-ISMETT), Palermo, Italy
| | - Giada Pietrosi
- Hepatology Unit, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Mediterranean Institute for Transplantation and Specialization Therapies (IRCCS-ISMETT), Palermo, Italy
| | - Fabrizio di Francesco
- Abdominal Surgery and Organ Transplant Unit, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Mediterranean Institute for Transplantation and Specialization Therapies (IRCCS-ISMETT), Palermo, Italy
| | - Giovanni Battista Vizzini
- Hepatology Unit, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Mediterranean Institute for Transplantation and Specialization Therapies (IRCCS-ISMETT), Palermo, Italy
| | - Angelo Luca
- Department of Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Specialization Therapies (IRCCS-ISMETT), Palermo, Italy
| | - Salvatore Gruttadauria
- Abdominal Surgery and Organ Transplant Unit, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Mediterranean Institute for Transplantation and Specialization Therapies (IRCCS-ISMETT), Palermo, Italy
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