Scandinavian Journal of Gastroenterology. 2012; 47: 710–717 ORIGINAL ARTICLE Impact of donor histology on survival following liver transplantation for chronic hepatitis C virus infection: A Scandinavian single-center experience MAGDALENA YDREBORG 1 , JOHAN WESTIN 1 , MARTIN LAGGING 1 , MARIA CASTEDAL 2 & STYRBJÖRN FRIMAN 2 1 Department of Infectious Diseases/Clinical Virology, Institute of Biomedicine, University of Gothenburg, Sweden, and 2 Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden Abstract Objective. Survival following liver transplantation for hepatitis C virus (HCV) infection is affected by several factors. The aims of this single-center study were to evaluate survival from 1992 to 2006 in HCV-infected liver transplant recipients and to identify factors influencing patient and graft survival, with particular focus on donor liver histopathology. Material and methods. Survival among 84 patients transplanted for HCV-related liver disease at the Sahlgrenska University Hospital during the above period was evaluated. Median follow-up time was 57 months (range 28–87). A perioperative liver biopsy from the donor liver graft was available in 68 cases. Biopsies were assessed for fibrosis, necroinflammatory activity, and degree of steatosis. Patient and graft survival according to relevant factors including donor histopathology were analyzed by Kaplan– Meier analysis. Results. We found an association between donor liver fibrosis and patient survival (p = 0.016) as well as between graft survival and portal inflammation in the donor liver (p = 0.026). Both these associations remained significant in multivariate analysis (p = 0.007 and 0.017 respectively). Moreover, recipient age over 60 was found predictive of patient survival and repeated steroid boluses or steroid-resistant rejection of graft survival. Donor age was high throughout the study period. Conclusion. Histopathological features, especially portal inflammation and stage of fibrosis, in the donor liver may deleteriously affect graft and patient survival following HCV-related liver transplantation. Thus, pretransplant evaluation of donor histopathology may be of value in the selection of donors for transplantation of HCV-positive individuals, especially among donors older than 60 years. Key Words: donor, hepatitis C virus infection, histopathology, liver transplantation, survival Introduction Hepatitis C virus (HCV)-associated end-stage liver dis- ease (ESLD) is the leading indication for elective liver transplantation in the United States and Europe [1,2], and in spite of having a relatively low incidence of HCV infection [3,4], the number of HCV-associated liver transplants in Sweden has increased markedly in recent years [5]. Though the overall outcome of liver trans- plantation has continuously improved over time for most other indications, reduced survival following HCV-associated liver transplantation has been reported in several studies [6]. Factors adversely affecting out- come following HCV-associated liver transplantation include higher recipient age [7], female gender [8], higher donor age [7–9], reactivation of cytomegalovirus (CMV) infection, use of steroid boluses to treat rejection episodes [10,11], reduction of overall immunosuppres- sion and avoidance of abrupt variations in immunosup- pression [12], and presence of steatosis in the donor graft [13]. Similarly, donor histology, especially the presence of portal inflammation, has been reported to adversely influence outcome in terms of fibrosis progression post-LT [14]. Correspondence: M. Ydreborg, Department of Infectious Diseases/Clinical Virology, Institute of Biomedicine, University of Gothenburg, Smörslottsgatan 1, 416 85 Gothenburg, Sweden. Fax: +46 31 84 78 13. E-mail: magdalena.ydreborg@gu.se (Received 16 January 2012; revised 20 February 2012; accepted 21 February 2012) ISSN 0036-5521 print/ISSN 1502-7708 online Ó 2012 Informa Healthcare DOI: 10.3109/00365521.2012.672592 Scand J Gastroenterol Downloaded from informahealthcare.com by Goteborgs University on 11/24/14 For personal use only.