Donor age influences 10-year liver graft histology independently of hepatitis C virus infection

Background/Aims

Factors influencing the long-term histological outcome of liver graft are not known. We conducted a prospective study based on a 10-year liver biopsy in order to identify the main factors influencing long-term graft histology.

Methods

270 of 423 patients who still had their first functional graft 10 years after liver transplantation accepted to undergo routine liver biopsy. All slides were blindly reviewed by two pathologists.

Results

Main histological findings were fibrosis in 143 patients (54%) and ductopenia in 76 patients (29%). Ductopenia was independently related to higher donor age (32±12 vs 28±13 years; P<0.02). Severity of fibrosis was influenced by hepatitis C virus (HCV) infection (P<0.001), hepatitis B virus (HBV) recurrence (P=0.001) and higher donor age (P=0.03). Eighty biopsies (30%) showed minimal-change lesions which were associated with the absence of HCV infection (24/80 vs 99/185; P<0.001) or of HBV infection (1/80 vs 15/185; P=0.03) and lower donor age (25±11 vs 31±13 years; P<0.001).

Conclusions

Post-transplant infection by HCV or HBV are main factors influencing the histological course of liver graft. Donor age was also a strong factor in HCV infected patients as well as in HCV-negative patients. This variable should be taken into account, particularly for candidate recipients with long life expectancy.

Keywords: ABO blood-group system, Adult, Age factors, Follow-up studies, Graft rejection, Graft survival, Human, Liver transplantation pathology, Liver transplantation, Tissue donors

Abbreviations: AIH, autoimmune hepatitis, CMV, cytomegalovirus, HBV, hepatitis B infection, HCV, hepatitis C infection, HCC, hepatocellular carcinoma, HDV, hepatitis D infection, OLT, orthotopic liver transplantation, PBC, primary biliary cirrhosis, χ², chi-square test