Hepatitis C infection in liver transplantation.
Hepatitis C-associated liver failure is the most common indication for liver transplantation and recurs nearly universally following transplantation. Histological evidence of recurrence is apparent in approximately 50% of HCV-infected recipients in the first postoperative year. Approximately 10% of HCV-infected recipients will die or lose their allograft secondary to hepatitis C-associated allograft failure in the medium term. While the choice of calcineurin inhibitor and/or the use of azathioprine have not been clearly shown to affect histological recurrence of hepatitis C or the frequency of rejection in hepatitis C-infected recipients, cumulative exposure to corticosteroids is associated with increased mortality, higher levels of HCV viremia and more severe histological recurrence. In contrast to nonhepatitis C-infected recipients, treatment for acute cellular rejection is associated with attenuated patient survival among recipients with hepatitis C. The development of steroid-resistant rejection is associated with a greater than five-fold increased risk of mortality in HCV-infected liver transplant recipients. In lieu of large studies in a post-transplant population therapy with pegylated interferon (+/- ribavirin) should be considered in recipients with histologically apparent recurrence of hepatitis C before total bilirubin exceeds 3 mg/dL. The role of hepatitis C immunoglobulin and new immunosuppression agents in the management of post-transplant hepatitis C infection is still evolving. Overall, HCV-infected recipients who undergo retransplantation experience 5-year patient and graft survival rates that are similar to recipients undergoing retransplantation who are not HCV-infected.
Charlton
M
M
Department of Gastroenterology and Hepatology, Mayo Clinic and Foundation, Rochester, MN 55905, USA. charlton.michael@mayo.edu
D006526:Hepatitis C / Q000150:complications* / Q000601:surgery; D006801:Humans; D017093:Liver Failure / Q000601:surgery* / Q000821:virology; D016031:Liver Transplantation / Q000401:mortality / Q000502:physiology; D011183:Postoperative Complications / Q000821:virology; D012086:Reoperation; D016019:Survival Analysis; D016896:Treatment Outcome