Garcia-Retortillo M et al. (2004) Hepatitis C recurrence is more severe after living donor compared to cadaveric liver transplantation. Hepatology 40: 699–707

Living donor liver transplantation (LDLT) is used as an alternative to cadaveric liver transplantation (CLT) because of the shortage of cadaveric donors. Some studies, however, have indicated a more aggressive course of HCV recurrence in LDLT recipients, and this may compromise graft and patient survival. Garcia-Retortillo and colleagues have therefore carried out a prospective study to compare the course of HCV recurrence in patients receiving LDLT or CLT.

A total of 116 consecutive HCV-infected patients underwent 117 liver transplantations. Of these, 95 (81%) were CLT and 22 (19%) were LDLT procedures. Following transplantation, viral load was measured in blood samples taken at 1, 4, 12, 24 and 48 weeks. The primary endpoint of the study was severe HCV recurrence, defined as either biopsy-proven cirrhosis or clinical decompensation.

After a median follow-up of 22 months, severe HCV recurrence had developed in only 18% of the patients undergoing CLT, compared with 41% of the LDLT patients. Multivariate analysis revealed that LDLT was a strong and independent predictor of severe recurrence (odds ratio 2.5, 95% CI 1.13–5.68, P = 0.025).

The authors advise that these results should be taken into account in liver transplant programs. They note, however, that this was a single-center study and so the data need to be validated.