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.