Review Article

Living-Donor Liver Transplantation and Hepatitis C

Table 1

Factors associated with the severity of recurrent hepatitis C after liver transplantation.

VariablesEffect on recurrent hepatitis C

Donor and graft factors
 Age [17, 3743]More severe disease (>40, >50, >65)
 Steatosis [56, 57, 7679]Few studies
 Prolonged ischemic time [54, 55, 8083]More severe disease
 HCV+ graft [6, 22, 40, 5053, 76]No influence
 Reduced size versus whole liver (LDLT versus DDLT) [39, 8495]No difference
Pretransplant recipient factors
 Genotype 1b [8, 32, 33, 35, 40]Controversial
 Pre-LT higher viral load [21, 28, 96, 97]Unclear
 Age [32, 44, 98]Few studies
 Race [45, 46, 99]Few studies
 Sex [20, 47, 48]Few studies
 HIV coinfection [100107]No influence
 IL-28B gene polymorphism [49, 108111]More severe disease in CT and TT genotype
Posttransplant recipient factors
 Post-LT higher viral load [10, 2731]More severe disease
 CMV infection [22, 29, 32, 112116]Unclear
 Diabetes mellitus (Metabolic syndrome) [29, 117121]More severe disease
Immunosuppression
 Steroid bolus/OKT3 [6, 21, 22, 58, 59, 122124]More severe disease
 Maintenance steroid [34, 6062, 122]Severe disease when rapidly tapered
 Steroid free regimen [6368, 125127]No influence
 Tacrolimus versus cyclosporine [6975]No difference
 Anti-IL-2 receptor antibodies [63, 126, 128131]Controversial
 Azathioprine/mycophenolate mofetil [132140]Controversial
 mTOR inhibitors [141143]Few studies

CMV: cytomegalovirus; DDLT: deceased-donor liver transplantation; HCV: hepatitis C virus; HIV: human immunodeficiency virus; LDLT: living-donor liver transplantation; LT: liver transplantation; mTOR: mammalian target of rapamycin.