Is recurrent hepatitis C worse with living donors?

PURPOSE OF REVIEW: Early reports suggested that hepatitis C virus (HCV) infection recurred with greater severity in recipients of living donor liver transplantation (LDLT) compared with recipients of deceased donor liver transplantation (DDLT). Consequently, there has been uncertainty in the transplant community as to whether to encourage use of live donors for patients undergoing transplantation for HCV. This review will present the current data regarding whether recurrent HCV is worse with living donors.

RECENT FINDINGS: More recently published studies have not corroborated the results of earlier studies showing inferior graft and patient survival in recipients of LDLT. The Adult-to-Adult Live Donor Liver Transplant Cohort Study showed that patient and graft survival in HCV-positive LDLT recipients was similar to that in DDLT recipients once centers had experience with LDLT. Additionally, studies using protocol liver biopsies to assess disease severity found no significant difference in the rate of fibrosis progression between recipients of LDLT and DDLT.

SUMMARY: There is no difference in graft survival or fibrosis progression between recipients of LDLT compared with DDLT with follow-up periods up to 5 years. Available data support the use of LDLT as an additional donor source for these patients.