Living donor liver transplantation in HCV-infected patients: Improvement of the donor risk-recipient benefit ratio is around the corner

摘要

Living donor liver transplantation (LDLT) has been a welcome alternative to deceased donor liver transplantation (DDLT), increasing the availability of donor livers overall and improving survival in individual patients [1, 2]. In experienced centers, operative outcomes of LDLT are almost comparable with DLDT [3, 4]. However, LDLT comes with substantial donor morbidity and, although rarely, acute hepatic insufficiency in the donor requiring transplantation and even donor death has been described [5]. From an ethical perspective, we must continually strive to improve the donor risk—recipient benefit ratio of LDLT. Currently, the most common indication for adult liver transplantation is complications from chronic hepatitis С virus (HCV) infection. HCV recurrence postliver transplant is almost universal and associated with poor graft and patient survival. The development of severe fibrosis or cir-, rhosis is accelerated after transplantation and the current antiviral treatment is not successful. This poses a major issue for the transplant community whether LDLT should be performed in HCV infection.