Background and Aim: The recurrence of the original disease affects liver transplantation (LT) outcome. 
Recurrence of viral and non-viral liver disease results in graft failure. This study aimed to analyze the factors 
responsible for disease recurrence after A-A LDLT and the effect of disease recurrence and its management on 
the outcome of LT. 
Subjects and Methods: After exclusion of 6 months mortality and pediatrics, thirty one alive transplanted 
patients were enrolled in the analysis in the follow up duration from 6 months to 60 months post 
transplantation. Univariate analysis and then multivariate analysis were done to detect the relationship 
between (demographic, preoperative, intraoperative and postoperative data) and overall recurrence and 
between recurrence variables and total survival in the follow up period. 
Results: Sixty nine patients underwent LDLT in our institute from April 2003 until the end of December 2009. 
The present retrospective study included 31 patients in the follow up duration and the incidence of recurrence 
was 15/31(48.4%) of patients (10 hepatitis C virus (HCV), 3 hepatocellular carcinoma (HCC) and 2 primary 
sclerosing cholangitis (PSC)). On univariate analysis, there was no statistically significant predictors of 
recurrence regarding (demographic, Preoperative, intraoperative and postoperative data). The overall 1-, 3-
and 5- year survivals of patients were 90.3%, 87.1% and 83.9% respectively, while the overall 1-, 3- and 5- year 
survivals of patients with and without recurrence were 86.7%, 80% and 73.3% and 93.8%, 93.8% and 93.8% 
respectively. 
Conclusion: Recurrence of primary disease after LDLT is confirmed in our study with the highest incidence in 
HCV patients. On the other hand HCV recurrence was higher in the following patients (Cytomegalovirus
(CMV) infections and with acute rejection). While HCC recurrence was higher in the following patients 
(Beyond Milan, with Alfa feto protein (AFP) >200 and patients with moderate tumor differentiation). 
Recurrence of primary disease after liver transplantation decreases post transplantation Survival. However its 
effective management improves survival.