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

Shigeru Marubashi, Keizo Dono, Hiroaki Nagano, Chiwan Kim, Tadafumi Asaoka, Naoki Hama, Shogo Kobayashi, Yutaka Takeda, Koji Umeshita, Morito Monden, Yuichiro Doki, Masaki Mori

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Abstract

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.

Original languageEnglish
Pages (from-to)904-913
Number of pages10
JournalClinical Transplantation
Volume23
Issue number6
DOIs
Publication statusPublished - Jan 1 2009
Externally publishedYes

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Living Donors
Hepatitis C
Hepacivirus
Liver Transplantation
Steroids
Recurrence
Immunosuppression
Mycophenolic Acid
Incidence
Virus Replication
Anti-Idiotypic Antibodies
Fibrosis
Prospective Studies
RNA

All Science Journal Classification (ASJC) codes

  • Transplantation

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Steroid-free living donor liver transplantation in adults : Impact on hepatitis C recurrence. / Marubashi, Shigeru; Dono, Keizo; Nagano, Hiroaki; Kim, Chiwan; Asaoka, Tadafumi; Hama, Naoki; Kobayashi, Shogo; Takeda, Yutaka; Umeshita, Koji; Monden, Morito; Doki, Yuichiro; Mori, Masaki.

In: Clinical Transplantation, Vol. 23, No. 6, 01.01.2009, p. 904-913.

Research output: Contribution to journalArticle

Marubashi, S, Dono, K, Nagano, H, Kim, C, Asaoka, T, Hama, N, Kobayashi, S, Takeda, Y, Umeshita, K, Monden, M, Doki, Y & Mori, M 2009, 'Steroid-free living donor liver transplantation in adults: Impact on hepatitis C recurrence', Clinical Transplantation, vol. 23, no. 6, pp. 904-913. https://doi.org/10.1111/j.1399-0012.2009.01022.x
Marubashi, Shigeru ; Dono, Keizo ; Nagano, Hiroaki ; Kim, Chiwan ; Asaoka, Tadafumi ; Hama, Naoki ; Kobayashi, Shogo ; Takeda, Yutaka ; Umeshita, Koji ; Monden, Morito ; Doki, Yuichiro ; Mori, Masaki. / Steroid-free living donor liver transplantation in adults : Impact on hepatitis C recurrence. In: Clinical Transplantation. 2009 ; Vol. 23, No. 6. pp. 904-913.
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AU - Marubashi, Shigeru

AU - Dono, Keizo

AU - Nagano, Hiroaki

AU - Kim, Chiwan

AU - Asaoka, Tadafumi

AU - Hama, Naoki

AU - Kobayashi, Shogo

AU - Takeda, Yutaka

AU - Umeshita, Koji

AU - Monden, Morito

AU - Doki, Yuichiro

AU - Mori, Masaki

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N2 - 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.

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