Hepatitis C recurrence similar in living donor, cadaver liver transplants, VCU study shows

By Lorraine Cichowski and Mitchell Shiffman

RICHMOND, Va. – Hepatitis C recurs in recipients of living donor liver transplants at a rate similar to that observed in patients who receive livers from deceased organ donors, according to a study at the Virginia Commonwealth University Medical Center.

The study, presented at the June 1 session of the American Transplant Congress 2003, www.atcmeeting.org, in Washington, D.C., disputed recent findings that recurrent hepatitis C may be more rapid and severe in patients following living donor liver transplants than in liver transplants from cadavers.

“Living donor liver transplants play such an important role in filling the gap between the number of patients with chronic hepatitis C in need of a new liver and the number of livers donated annually,” said Mitchell L. Shiffman, M.D., professor of medicine, chief of the Hepatology Section and medical director of the Liver Transplant Program at the VCU Medical Center. “We don’t want to cut off that option for patients because of fears that a liver from a live donor might worsen their hepatitis C in the future.”

Hepatitis C is an inflammation of the liver caused by the hepatitis C virus, which is found in the blood of people who have the disease. Hepatitis C is the most common chronic blood-borne infection in the United States, and hepatitis C-caused cirrhosis is the leading reason for liver transplants. According to the Centers for Disease Control and Prevention, approximately 1.8 percent of the U.S. population, or 3.9 million Americans, has been infected with hepatitis C; about 35,000 new cases occur annually. If left untreated, hepatitis C can lead to cirrhosis, liver failure, liver cancer and possibly death.

Because hepatitis C can live in cells other than in the liver, the disease frequently spreads back into the liver after a transplant, often worsening at a rate faster than would be expected in a non-transplant patient because of the transplant patient’s suppressed immune system. Physicians who treat liver transplant patients, therefore, are very concerned about recurrent hepatitis C.

The VCU transplant team followed 22 patients with hepatitis C who received livers from live donors between July 1998 and December 2001 at the VCU Medical Center and 53 who received liver transplants from cadavers during the same period. The patients were mostly male (82 percent), with an average age of 47. The researchers found that the severity of recurrent Hepatitis C worsened during the three years following surgery for both groups, but no statistically significant difference was observed.

After three years, 79 percent of the living donor liver transplant (LDLT) patients and 91 percent of the patients who received donors from cadavers still were alive. Acute rejection of the transplanted liver occurred in 14 percent of the LDLT patients and 21 percent of the other patients. About half of both groups developed portal fibrosis, which is a liver disease preceding cirrhosis.

Adult-to-adult living donor liver transplantation started becoming popular in the late 1990s when the shortage of donated livers for adults began to increase, along with the waiting list for liver transplantation.  Currently, more than 17,000 Americans with liver disease are waiting to receive a liver transplant. Only 4,500 donated livers were available for transplant last year from the deceased.