Steroid-free living donor liver transplantation in adults: impact on hepatitis C recurrence.

INTRODUCTION

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).

PATIENTS AND 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.