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Living Donor and Split‐Liver Transplants in Hepatitis C Recipients: Does Liver Regeneration Increase the Risk for Recurrence?
Author(s) -
Humar Abhinav,
Horn Kirsten,
Kalis Ann,
Glessing Brooke,
Payne William D.,
Lake John
Publication year - 2005
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/j.1600-6143.2004.00704.x
Subject(s) - medicine , gastroenterology , hepatitis c virus , fibrosis , liver disease , biopsy , hepatitis c , liver biopsy , hepatitis , incidence (geometry) , surgery , immunology , virus , physics , optics
Concern exists that partial liver transplants (either a living donor [LD] or deceased donor [DD] in hepatitis C virus (HCV)‐positive recipients may be associated with an increased risk for recurrence. From 1999 to 2003, at our institution, 51 HCV‐positive recipients underwent liver transplants: 32 whole‐liver (WL) transplants, 12 LD transplants and 7 DD split transplants. Donor characteristics differed in that WL donors were older, and LD livers had lower ischemic times. Recipient characteristics were similar except that mean MELD scores in LD recipients were lower (p < 0.05). With a mean follow‐up of 28.3 months, 46 (90%) recipients are alive: three died from HCV recurrent liver disease and two from tumor recurrence. Based on 1‐year protocol biopsies, the incidence of histologic recurrence in the three groups is as follows: WL, 81%; LD, 50% and DD split, 86% (p = 0.06 for LD versus WL). The mean grade of inflammation on the biopsy specimens was: WL, 1.31; LD, 0.33 and DD split, 1.2 (p = 0.002 for LD versus WL; p = 0.03 for LD versus DD split). Mean stage of fibrosis was: WL, 0.96; LD, 0.22 and DD split, 0.60 (p = 0.07 for LD versus WL). Liver regeneration does not seem to affect hepatitis C recurrence as much, perhaps, as factors such as DD status, donor age and cold ischemic time.