Steroid-free living donor liver transplantation in adults: impact on hepatitis C recurrence.
BACKGROUND
Although steroid-free immunosuppression has been proven to be safe and feasible for liver transplantation, its impact on hepatitis C virus (HCV) recurrence remains unknown. We aimed to clarify the impact of steroid-free immunosuppression on post-operative HCV recurrence after living donor liver transplantation (LDLT).


METHODS
Of 32 adult patients with HCV cirrhosis who underwent LDLT between 1999 and 2007 at our hospital, 28 were enrolled in this prospective study. We used steroid-free immunosuppression, consisting of a calcineurin inhibitor, mycophenolate mofetil and anti-CD25 antibody in 18 patients (F-group), and the remaining 10 patients received steroid-based immunosuppression (S-group) during the same period.


RESULTS
Patient characteristics were similar between the two groups. Steroid-free immunosuppression was associated with lower incidence of CMV infection (p = 0.049) and higher incidence of instituting preemptive anti-HCV therapy (p = 0.015) without increasing acute cellular rejection in the F-group than that in the S-group. In the early period after LDLT, the serum HCV-RNA level remained suppressed in the F-group, whereas it increased rapidly in the S-group (p < 0.05). HCV recurrence was less frequent in the F-group (18.1% at one yr) than in the S-group (46.0%) (p = 0.009).


CONCLUSIONS
Steroid-free immunosuppression was confirmed to be safe and feasible for HCV-positive recipients in LDLT, and was associated with suppressed HCV replication and HCV recurrence after LDLT.
Marubashi
Shigeru
S
Department of Surgery, Osaka University, Graduate School of Medicine, Suita, Osaka, Japan. maru@surg2.med.osaka-u.ac.jp
Dono
Keizo
K
Nagano
Hiroaki
H
Kim
Chiwan
C
Asaoka
Tadafumi
T
Hama
Naoki
N
Kobayashi
Shogo
S
Takeda
Yutaka
Y
Umeshita
Koji
K
Monden
Morito
M
Doki
Yuichiro
Y
Mori
Masaki
M
D000328:Adult; D000075202:Contraindications; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000517:prevention & control*; D016174:Hepacivirus / Q000276:immunology; D006526:Hepatitis C / Q000150:complications / Q000517:prevention & control* / Q000821:virology; D018937:Hepatitis C Antibodies / Q000032:analysis; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008103:Liver Cirrhosis / Q000209:etiology / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D055502:Secondary Prevention; D013256:Steroids; D016896:Treatment Outcome
D018937:Hepatitis C Antibodies; D007166:Immunosuppressive Agents; D013256:Steroids