Accelerated hepatitis C virus kinetics but similar survival rates in recipients of liver grafts from living versus deceased donors.
This study tested the hypothesis that hepatitis C virus (HCV) RNA and core antigen levels rise more rapidly after liver transplantation (LT) in recipients of grafts from living donors (LD) versus deceased donors (DD). Eleven consecutive LD and 15 DD recipients were followed prospectively. Before LT, median HCV RNA levels were similar: 5.42 (LDLT) and 5.07 (DDLT) log(10) IU/mL (P = NS). During the first 7 hours after LT a trend toward a greater HCV RNA decrease in LDLT patients was seen, although they received fewer blood replacement products during surgery. HCV RNA levels rose more rapidly in LDLT patients between days 1 and 3 (P = .0059) and were higher in this group on days 2, 3, 4, and 5. Core antigen levels were significantly higher in LDLT patients on days 3 and 5, although they were similar before LT (P = NS). Alanine aminotransferase (ALT) values were higher among LDLT patients from 8 to 14 days and from 4 to 24 months. Two-year graft and patient survival were 73% for LDLT patients and 80% for DDLT patients (P = NS). In conclusion, viral load rose more rapidly in LD recipients and reached higher levels shortly after surgery. Greater ALT elevations were evident in the LDLT group, but survival rates were similar. The trend toward a greater initial viral load decrease in patients with LD grafts and the significantly sharper increase suggest that the liver plays a predominant role in both HCV clearance and replication.
Schiano
Thomas D
TD
The Recanati/Miller Transplantation Institute, The Mount Sinai Hospital, New York, NY, USA.
Gutierrez
Julio A
JA
Walewski
Jose L
JL
Fiel
M Isabel
MI
Cheng
Bonnie
B
Bodenheimer
Henry
H
Thung
Swan N
SN
Chung
Raymond T
RT
Schwartz
Myron E
ME
Bodian
Carol
C
Branch
Andrea D
AD
D000293:Adolescent; D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D002102:Cadaver; D016174:Hepacivirus / Q000302:isolation & purification*; D006526:Hepatitis C / Q000821:virology*; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality*; D019520:Living Donors; D008875:Middle Aged; D012367:RNA, Viral / Q000032:analysis; D012008:Recurrence; D012254:Ribavirin / Q000627:therapeutic use; D015996:Survival Rate; D014758:Viral Core Proteins / Q000032:analysis; D019562:Viral Load
D012367:RNA, Viral; D014758:Viral Core Proteins; D012254:Ribavirin; D000410:Alanine Transaminase