Steroid-free living donor liver transplantation for HCV - a multicenter prospective cohort study in Japan

Shigeru Marubashi, Koji Umeshita, Toshimasa Asahara, Kenji Fujiwara, Hironori Haga, Takashi Hashimoto, Katsuyoshi Hatakeyama, Takafumi Ichida, Takashi Kanematsu, Masaki Kitajima, Kendo Kiyosawa, Masatoshi Makuuchi, Shinichi Miyagawa, Susumu Satomi, Yuji Soejima, Yasutsugu Takada, Noriaki Tanaka, Satoshi Teraoka, Morito Monden

Research output: Contribution to journalArticlepeer-review

7 Citations (Scopus)

Abstract

This prospective, non-randomized, multicenter cohort study analyzed the safety and efficacy of a steroid-free immunosuppressive (IS) protocol for hepatitis C virus (HCV)-positive living donor liver transplant (LDLT) recipients in Japan. Of 68 patients enrolled from 13 transplant centers, 56 fulfilled the inclusion/exclusion criteria; 27 were assigned the steroid-free IS protocol (Fr group) and 29 the traditional steroid-containing IS protocol (St group). Serum HCV RNA levels increased over time and were higher in the St group until postoperative day 90 (POD 14, p = 0.013). Preemptive anti-HCV therapy was started in a higher percentage of recipients (59.3%) in the Fr group than in the St group (31.0%, p = 0.031), mainly due to early HCV recurrence. The incidence of HCV recurrence at one yr was lower in the Fr group (22.2%) than in the St group (41.4%; p = 0.066). The incidence of acute cellular rejection was similar between groups. New onset diabetes after transplant, cytomegalovirus infection, and renal dysfunction were significantly less frequent in the Fr group than in the St group (p = 0.022, p < 0.0001, p = 0.012, respectively). The steroid-free IS protocol safely reduced postoperative morbidity and effectively suppressed both the HCV viral load in the early post-transplant period and HCV recurrence in HCV-positive LDLT recipients.

Original languageEnglish
Pages (from-to)857-867
Number of pages11
JournalClinical Transplantation
Volume26
Issue number6
DOIs
Publication statusPublished - 2012 Nov

Keywords

  • Corticosteroid
  • Hepatitis C
  • Immunosuppression
  • Liver transplantation
  • Multicenter study

ASJC Scopus subject areas

  • Transplantation

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