We read with interest the article by Thuluvath and Yoo comparing graft and patient survival in adult living donor liver transplant recipients (LDLT) to deceased donor recipients. 1 Using data from 1988 -2001 from the United Network for Organ Sharing database, they found lower graft survival in the LDLT group compared to the deceased donor group, including LDLT recipients with hepatitis C. We believe these results should be interpreted with caution, based upon an analysis we published comparing graft and patient survival in living donor and deceased donor liver transplant recipients with hepatitis C transplanted from 1999 to 2002. 2 We, too, found that graft survival was lower in the living donor group with hepatitis C compared to the deceased donor group (among those who were hepatitis C antibody positive). However, a closer look at that data showed that 1-year graft survival in the LDLT group increased from 51% to 77% from 1999 to 2000. In 2001, 1-year graft survival was 78% in the LDLT group and 83% in the deceased donor group (P Ο not significant). Although the authors state that most graft loss occurred in the first year, they did not report survival rates after excluding recipients transplanted in 1998 and 1999. As they show in Figure 1 of their article, 1999 was the first year that a substantial number of LDLTs were performed. Because improvements in graft survival in the LDLT group were seen from 1999 to 2000, we believe that studies on LDLT should report results by year of transplantation or also report results after excluding LDLT recipients transplanted in 1998 and 1999, particularly those utilizing the United Network for Organ Sharing database. The lower graft survival rates seen in LDLT recipients transplanted in 1999 may reflect early experience with the procedure and a "learning curve" phenomenon. Inclusion of recipients during this time period may not accurately reflect current outcomes.
In addition, in their study the authors identified recipients with hepatitis C using diagnostic codes. We and others have found that using the diagnostic code to identify recipients with hepatitis C may not be as accu-rate in identifying recipients with hepatitis C as using the hepatitis C diagnostic code plus hepatitis C antibody results. 2,3 Studies utilizing the United Network for Organ Sharing database that report outcomes in recipients with hepatitis C should include data from recipients diagnosed with hepatitis C who are hepatitis C antibody positive.