Living Donor and Split-Liver Transplants in Hepatitis C Recipients: Does Liver Regeneration Increase the Risk for Recurrence?
Article first published online: 12 NOV 2004
American Journal of Transplantation
Volume 5, Issue 2, pages 399–405, February 2005
How to Cite
Humar, A., Horn, K., Kalis, A., Glessing, B., Payne, W. D. and Lake, J. (2005), Living Donor and Split-Liver Transplants in Hepatitis C Recipients: Does Liver Regeneration Increase the Risk for Recurrence?. American Journal of Transplantation, 5: 399–405. doi: 10.1111/j.1600-6143.2004.00704.x
- Issue published online: 12 NOV 2004
- Article first published online: 12 NOV 2004
- Received 26 July 2004, revised and accepted for publication 27 September 2004
- Hepatitis C recurrence;
- living donor liver;
- protocol biopsy;
- risk factors;
- split livers
Concern exists that partial liver transplants (either a living donor [LD] or deceased donor [DD] in hepatitis C virus (HCV)-positive recipients may be associated with an increased risk for recurrence. From 1999 to 2003, at our institution, 51 HCV-positive recipients underwent liver transplants: 32 whole-liver (WL) transplants, 12 LD transplants and 7 DD split transplants. Donor characteristics differed in that WL donors were older, and LD livers had lower ischemic times. Recipient characteristics were similar except that mean MELD scores in LD recipients were lower (p < 0.05). With a mean follow-up of 28.3 months, 46 (90%) recipients are alive: three died from HCV recurrent liver disease and two from tumor recurrence. Based on 1-year protocol biopsies, the incidence of histologic recurrence in the three groups is as follows: WL, 81%; LD, 50% and DD split, 86% (p = 0.06 for LD versus WL). The mean grade of inflammation on the biopsy specimens was: WL, 1.31; LD, 0.33 and DD split, 1.2 (p = 0.002 for LD versus WL; p = 0.03 for LD versus DD split). Mean stage of fibrosis was: WL, 0.96; LD, 0.22 and DD split, 0.60 (p = 0.07 for LD versus WL). Liver regeneration does not seem to affect hepatitis C recurrence as much, perhaps, as factors such as DD status, donor age and cold ischemic time.