Living donor liver transplantation for patients with hepatitis C virus cirrhosis: Tokyo experience.

Living donor liver transplantation is an alternative therapeutic option for patients with end-stage HCV cirrhosis because of the cadaveric organ shortage. Preliminary results, however, indicate that live donor grafts might be disadvantageous for HCV patients. Sixty-seven patients underwent living donor liver transplantation for HCV cirrhosis between 1996 and 2004. All the patients preemptively received antiviral therapy consisting of interferon alfa-2b and ribavirin, which was started approximately 1 month after the operation. The therapy continued for 12 months after the first negative HCV RNA test. The patients were then observed without the therapy for 6 months. The therapy was continued for at least 12 months, even when the HCV RNA test remained positive. The subjects were removed from the protocol if they could not continue the therapy for 12 months because of adverse effects or could not start the therapy because of early death. Twelve patients were removed from the protocol as a result of early death (n = 9) or cessation of the drug (n = 3). Another 16 patients are currently on the protocol. Of the remaining 39 patients, 16 patients (41%) had a sustained virologic response. The cumulative 5-year survival of the HCV-positive patients was 84%, which was comparable with that of patients negative for HCV (n = 168, 86%). The present preemptive antiviral protocol after living donor liver transplantation is safe and warrants a controlled study to confirm its benefit on graft survival.