Hepatitis-C-virus- (HCV-) related end-stage cirrhosis is the primary indication for liver transplantation in many countries. Unfortunately, however, HCV is not eliminated by transplantation and graft reinfection is universal, resulting in fibrosis, cirrhosis, and finally graft decompression. In areas with low deceased-donor organ availability like Japan, living-donor liver transplantation (LDLT) is similarly indicated for HCV cirrhosis as deceased-donor liver transplantation (DDLT) in Western countries and accepted as an established treatment for HCV-cirrhosis, and the results are equivalent to those of DDLT. To prevent graft failure due to recurrent hepatitis C, antiviral treatment with pegylated-interferon and ribavirin is currently considered the most promising regimen with a sustained viral response rate of around 30% to 35%, although the survival benefit of this regimen remains to be investigated. In contrast to DDLT, many Japanese LDLT centers have reported modified treatment regimens as best efforts to secure first graft, such as aggressive preemptive antiviral treatment, escalation of dosages, and elongation of treatment duration. 1. Introduction Since the first successful application of living donor liver transplantation (LDLT) in 1990 [1] and subsequent successful LDLT for adult recipient in 1994 [2], the use of live donors for liver transplantation has been widely applied to adult recipients where the availability of deceased-donors is severely restricted, like in Japan [3], and also accepted as a solution to the cadaveric donor shortage in Western countries [4]. End-stage liver disease caused by chronic hepatitis C virus (HCV) infection is the leading cause of liver transplantation in developed countries [5, 6], including Japan [7]. Unfortunately, liver transplantation does not cure HCV-infected recipients, but re-infection of HCV universally occurs and disease progression is accelerated compared with that in the nontransplant population, resulting in poor outcomes for HCV-infected recipients [8]. The aim of this paper was to overview the current trends and controversies in LDLT for patients with HCV in relation to the perspectives from deceased-donor liver transplantation (DDLT). 2. Natural History of Hepatitis C after Orthotopic Liver Transplantation Accumulating perspectives of disease recurrence in HCV-infected recipients have been obtained in DDLT within the last two decades. HCV reinfection occurs just after reperfusion followed by a rapid increase in HCV ribonucleic acid (RNA) levels within 4 postoperative months [9]. The histologic
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