Steroid‐free living donor liver transplantation for HCV – a multicenter prospective cohort study in Japan |
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| Authors: | 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 |
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| Institution: | 1. Department of Surgery, Osaka University Graduate School of Medicine, , Suita, Osaka, Japan;2. Graduate School of Medicine, Hiroshima University, , Hiroshima, Japan;3. Yokohama Rosai Hospital, , Yokohama, Japan;4. Department of Diagnostic Pathology, Graduate School of Medicine, Kyoto University, , Kyoto, Japan;5. Department of Pediatric Surgery, Fujita Health University, , Nagoya, Japan;6. Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, , Niigata, Japan;7. Division of Gastroenterology and Hepatology, Juntendo University School of Medicine Shizuoka Hospital, , Shizuoka, Japan;8. Department of Surgery, Nagasaki University Graduate School of Biomedical Science, , Nagasaki, Japan;9. Department of Surgery, Keio University School of Medicine, , Tokyo, Japan;10. Department of Internal Medicine, Division of Hepatology and Gastroenterology, Shinshu University School of Medicine, , Matsumoto, Japan;11. Division of Hepato‐Biliary‐Pancreatic and Transplantation Surgery, Department of Surgery, Graduate School of Medicine, University of Tokyo, , Tokyo, Japan;12. Department of Surgery, Shinshu University School of Medicine, , Matsumoto, Japan;13. Division of Advanced Surgical Science and Technology, Tohoku University, , Sendai, Japan;14. Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, , Fukuoka, Japan;15. Department of Surgery, Graduate School of Medicine, Kyoto University, , Kyoto, Japan;16. Department of Gastroenterological Surgery, Transplant, and Surgical Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, , Okayama, Japan;17. Department of Surgery, Kidney Center, Tokyo Women's Medical University, , Tokyo, Japan |
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| 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. |
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| Keywords: | corticosteroid hepatitis C immunosuppression liver transplantation multicenter study |
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