Hepatitis C recurrence and fibrosis progression are not increased after living donor liver transplantation: a single-center study of 289 patients.

Today, hepatitis C virus (HCV) is the leading cause for liver transplantation (LT) and viral recurrence is almost universal. It has been suggested that viral replication within the transplanted tissue might be increased in organs of reduced size such as LD grafts. In the current literature the data is controversial, with many studies lacking routine liver biopsies. We performed a retrospective analysis of 289 HCV-LT (20 LD splits) patients receiving transplants between 1997 and 2005. Patient and organ survival, intensity of HCV recurrence, and fibrosis progression were analyzed with respect to deceased donor (DD) LT (DDLT) or living donor (LD) LT (LDLT). Organ and patient survival was significantly better for full-size recipients than for split-liver patients, with P = 0.037 for organ survival and P = 0.037 for patient survival; yet there were no significant differences when split-liver patients with large hepatocellular carcinoma (HCC) beyond the Milan criteria (n = 3) were excluded from the analysis (P > 0.05). First year fibrosis progression was 1.29 in full-size grafts and 1.07 in split-livers (P = not significant). In conclusion, in our patient sample, intensity of HCV recurrence was not increased in LD graft recipients compared to full-size recipients. Patient and organ survival were similar when patients with large HCC and early tumor recurrence were excluded from analysis. LDLT can therefore be advocated for HCV patients.