Severe hepatitis C recurrence is more common in transplants from living donors

Sep 9 2004

Hepatitis C recurs with severity more often in individuals who receive liver transplants from living donors compared with those who get transplants from cadavers, according to a new study published in the September 2004 issue of Hepatology.

Hepatology, the official journal of the American Association for the Study of Liver Diseases (AASLD), published by John Wiley & Sons, Inc., is available online via Wiley InterScience.

Hepatitis C recurs in all patients after liver transplantation, but certain factors, such as high viral load and increased donor age, have been associated with more severe recurrence. Some studies have also suggested that HCV recurs earlier and more severely in patients who receive liver transplants from living, as opposed to deceased, donors.

Researchers led by Xavier Forns of the Hospital Clinic in Barcelona, investigated the effect of donor life status on outcomes of HCV patients receiving liver transplants. They examined a cohort of 116 consecutive HCV-infected patients undergoing liver transplantation for end-stage cirrhosis or hepatocellular carcinoma between March 2000 and August 2003. Ninety-five of the patients received livers from cadavers while 22 received livers from living donors.

The researchers recorded 29 variables potentially associated with severe HCV recurrence, including recipient age and gender, HCV genotype, and pre-transplantation viral load. After transplantation, they followed up with patients clinically, performing liver biopsies when possible. They defined severe HCV recurrence as the presence of liver cirrhosis in a liver biopsy or the development of clinical decompensation secondary to liver disease with portal hypertension. The researchers then used statistical analyses to determine which variables were associated with severe recurrence.

After a median follow-up period of 22 months, 26 of the patients developed severe HCV recurrence. Of the 95 patients who had received cadaveric liver transplantation, 17 (18 percent) had severe recurrence. Of the 22 who had undergone living donor transplantation, 9 (41 percent) had severe recurrence. By univariate analysis, living donor transplant, as well as significant necroinflammation in an early liver biopsy and biliary complications after liver transplantation were predictive of severe HCV recurrence. The association between liver donor transplant and severe HCV recurrence remained significant even after the authors adjusted for confounding variables known to be associated with recurrent hepatitis C.

"Our data, though limited to a single center, show that living donor liver transplantation is a strong and independent predictor of severe HCV disease recurrence following transplantation," the authors report. "Accordingly, the 2-year probability of presenting severe recurrence was significantly higher in living donor liver transplantation compared to cadaveric liver transplantation."

The mechanisms that would explain the recurrence are unknown, though the authors theorized that either biliary complications or liver regeneration would accelerate liver fibrosis.

"In summary, our data indicate that living donor liver transplantation is a strong predictor of severe HCV disease recurrence after transplantation," the authors conclude. "Although the data need to be validated, the more aggressive course of HCV infection in living donor compared to cadaveric transplantation should be considered in LDLT programs, since it may ultimately compromise graft and patient survival."

An editorial by Mark W. Russo and Roshan Shrestha of the University of North Carolina, in the same issue of Hepatology lauds the study's design, but points out that its conclusions conflict with other similar studies, and suggests that the results may not apply to all populations.

"The benefits of living donor liver transplantation should not be overlooked," the editorialists say, and "must be considered before making a premature decision about the risk of recurrent hepatitis C with living donor liver transplantation."