title: Increased risk of cholestatic hepatitis C in recipients of grafts from living versus cadaveric liver donors.
abstract: Histologic injury caused by recurrent hepatitis C virus (HCV) has been reported in up to 90% of HCV-infected patients who undergo liver transplantation with a cadaveric graft. However, the natural history of HCV after living donor liver transplantation (LDLT) is not well described. We performed a retrospective analysis of 68 consecutive HCV-infected adult patients: 45 recipients of cadaveric grafts (CAD) were compared with 23 LDLT patients. Elevated serum transaminases, positive HCV RNA, and liver biopsy consistent with histologic evidence of HCV defined recurrence. When comparing CAD with LDLT, both the incidence of HCV recurrence and time to recurrence were not different. The overall incidence of severe sequelae of HCV recurrence, either cholestatic hepatitis, grade III-IV inflammation, and/or HCV-induced graft failure requiring retransplantation, was also not different when comparing CAD with LDLT. However, when comparing CAD versus LDLT, no CAD patient developed cholestatic hepatitis C, compared with 17% of LDLT who developed this complication (P =.001). Thus, in this patient population, the timing and incidence of HCV recurrence were not different when comparing CAD versus LDLT, but the incidence of cholestatic hepatitis was significantly greater in patients with HCV who underwent LDLT.
authors.affiliation: Department of Medicine, Columbia University College of Physicians and Surgeons, Center for Liver Disease and Transplantation, New York-Presbyterian Hospital, New York, NY 10032, USA. pg2011@columbia.edu
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Gaglio
authors.forename: Srikar
authors.initials: S
authors.lastname: Malireddy
authors.forename: Brian S
authors.initials: BS
authors.lastname: Levitt
authors.forename: Dianne
authors.initials: D
authors.lastname: Lapointe-Rudow
authors.forename: Jay
authors.initials: J
authors.lastname: Lefkowitch
authors.forename: Milan
authors.initials: M
authors.lastname: Kinkhabwala
authors.forename: Mark W
authors.initials: MW
authors.lastname: Russo
authors.forename: Jean C
authors.initials: JC
authors.lastname: Emond
authors.forename: Robert S
authors.initials: RS
authors.lastname: Brown
mesh_terms: D000328:Adult; D002102:Cadaver; D002780:Cholestasis, Intrahepatic / Q000453:epidemiology*; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D019698:Hepatitis C, Chronic / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D006801:Humans; D015994:Incidence; D016031:Liver Transplantation / Q000401:mortality*; D019520:Living Donors / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000473:pathology; D012008:Recurrence; D012307:Risk Factors; D016019:Survival Analysis