title: Steroid-free living donor liver transplantation for HCV--a multicenter prospective cohort study in Japan.
abstract: This prospective, non-randomized, multicenter cohort study analyzed the safety and efficacy of a steroid-free immunosuppressive (IS) protocol for hepatitis C virus (HCV)-positive living donor liver transplant (LDLT) recipients in Japan. Of 68 patients enrolled from 13 transplant centers, 56 fulfilled the inclusion/exclusion criteria; 27 were assigned the steroid-free IS protocol (Fr group) and 29 the traditional steroid-containing IS protocol (St group). Serum HCV RNA levels increased over time and were higher in the St group until postoperative day 90 (POD 14, p=0.013). Preemptive anti-HCV therapy was started in a higher percentage of recipients (59.3%) in the Fr group than in the St group (31.0%, p=0.031), mainly due to early HCV recurrence. The incidence of HCV recurrence at one yr was lower in the Fr group (22.2%) than in the St group (41.4%; p=0.066). The incidence of acute cellular rejection was similar between groups. New onset diabetes after transplant, cytomegalovirus infection, and renal dysfunction were significantly less frequent in the Fr group than in the St group (p=0.022, p<0.0001, p=0.012, respectively). The steroid-free IS protocol safely reduced postoperative morbidity and effectively suppressed both the HCV viral load in the early post-transplant period and HCV recurrence in HCV-positive LDLT recipients.
authors.affiliation: Department of Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Marubashi
authors.forename: Koji
authors.initials: K
authors.lastname: Umeshita
authors.forename: Toshimasa
authors.initials: T
authors.lastname: Asahara
authors.forename: Kenji
authors.initials: K
authors.lastname: Fujiwara
authors.forename: Hironori
authors.initials: H
authors.lastname: Haga
authors.forename: Takashi
authors.initials: T
authors.lastname: Hashimoto
authors.forename: Katsuyoshi
authors.initials: K
authors.lastname: Hatakeyama
authors.forename: Takafumi
authors.initials: T
authors.lastname: Ichida
authors.forename: Takashi
authors.initials: T
authors.lastname: Kanematsu
authors.forename: Masaki
authors.initials: M
authors.lastname: Kitajima
authors.forename: Kendo
authors.initials: K
authors.lastname: Kiyosawa
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Makuuchi
authors.forename: Shinichi
authors.initials: S
authors.lastname: Miyagawa
authors.forename: Susumu
authors.initials: S
authors.lastname: Satomi
authors.forename: Yuji
authors.initials: Y
authors.lastname: Soejima
authors.forename: Yasutsugu
authors.initials: Y
authors.lastname: Takada
authors.forename: Noriaki
authors.initials: N
authors.lastname: Tanaka
authors.forename: Satoshi
authors.initials: S
authors.lastname: Teraoka
authors.forename: Morito
authors.initials: M
authors.lastname: Monden
mesh_terms: D004279:DNA, Viral / Q000097:blood / Q000235:genetics; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000188:drug therapy* / Q000401:mortality; D016174:Hepacivirus / Q000235:genetics; D006526:Hepatitis C / Q000097:blood / Q000601:surgery* / Q000821:virology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007564:Japan; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D013256:Steroids / Q000008:administration & dosage*; D015996:Survival Rate
chemical_list: D004279:DNA, Viral; D007166:Immunosuppressive Agents; D013256:Steroids