Hwang et al. reported that the total amount of hepatic steatosis in nine living donors changed significantly from 48.9% ± 25.6% before 2–6 months of weight reduction (loss of 5.9% ± 2.0% of initial body weight) to 20.0% ± 16.2% after

weight reduction.40 All donors recovered uneventfully and all recipients survived AUY-922 more than 15 months. This type of intervention, if the general condition of the recipient permits, will contribute to expanding the pool of marginal living doors. Hepatitis C virus (HCV) recurrence is universal and is associated with poor graft and patient survival. Pre-emptive antiviral therapy started within weeks of transplantation is limited by tolerability. Rates of sustained virological response (SVR) vary from 8% to 39%.41,42 Post-transplant antiviral therapy initiated upon histological evidence of recurrence is therefore the mainstay of treatment. Most recently, KU57788 the Kyoto group reported that a combination of pegylated interferon alpha-2b and ribavirin achieved a 50% SVR rate for recurrent hepatitis C genotype 1b.43 In contrast, pretransplant therapy is a favorable option for well-compensated patients with HCC or

mildly decompensated liver cirrhosis, since up to two-thirds of patients who become HCV RNA-negative on treatment are suggested to be HCV infection-free after LT.42 From the analysis of 275 patients who underwent pretransplant antiviral therapy selleck inhibitor with mostly mild to moderate liver decompensation, receiving either LDLT or DDLT, rates of on-treatment SVR were 30% (range, 18–56%) in genotype

1 and 83% (range, 82–100%) in genotype 2/3 recipients.42,44 Whether HCV-infected LDLT recipients show worse graft outcomes than HCV-infected DDLT recipients has been controversial. The retrospective A2ALL cohort study recently demonstrated that graft survival did not differ significantly for recipients of LDLT compared with DDLT once centers have sufficient experience with LDLT.45 The risks to the healthy live donor represent the greatest disadvantage for LDLT. As noted earlier, the healthy live donor undergoes major surgery for no direct, physical benefit. The Japanese Liver Transplantation Society collected data from 3565 live donors and reported that 299 donors (8.4%) suffered complications related to live donation, with one donor death.46 A worldwide systematic review reported that donor morbidity ranged from 0% to 100%, with a median of 16.1%.47 Biliary complications and infections were the most commonly reported donor morbidities, with median frequencies of 6.2% and 5.8%, respectively. Based on the estimate of 14 000 LDLTs performed worldwide, the donor death rate is 0.1–0.3%.1 The A2ALL group investigated the rate and severity of complications in 393 living donors.48 Eighty-two donors (21%) experienced one complication, and 66 (21%) had two or more.