Recurrent hepatitis C following liver transplant: diagnosis, natural history, and therapeutic options.
Hepatitis C virus (HCV) related cirrhosis is the most common indication for orthotopic liver transplantation (OLT). Updated data suggest worse long-term outcomes for those transplanted with HCV than those transplanted for other indications. Re-infection with HCV post-OLT is universal, therefore diagnosis of recurrence should be based on histological findings in the setting of persistent viremia. Variables associated with worse outcome of recurrent disease include early recurrence, degree of immunosuppression, and donor age. Antiviral therapy has been used in the prevention and treatment of recurrent disease, and can be initiated prior to transplantation, prophylactically after transplantation, and during recurrence. Preliminary studies of pre-transplantation treatment demonstrate virological responses, but tolerance is common. Higher efficacy has been associated with combination therapy for recurrent disease. Adverse effects limit its widespread use.
Saab
Sammy
S
MPH Division of Digestive Diseases 44-138 CHS (MC 168417), UCLA Medical Center, 10833 Le Conte Avenue Los Angeles, CA 90095, USA. Ssaab@mednet.ucla.edu
Wang
Victor
V
D000998:Antiviral Agents / Q000627:therapeutic use; D005838:Genotype; D016174:Hepacivirus / Q000235:genetics; D006526:Hepatitis C / Q000175:diagnosis / Q000276:immunology / Q000601:surgery / Q000628:therapy*; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000601:surgery / Q000821:virology; D016031:Liver Transplantation / Q000276:immunology; D011092:Polyethylene Glycols / Q000627:therapeutic use; D011184:Postoperative Period; D011994:Recombinant Proteins; D012008:Recurrence; D012254:Ribavirin / Q000627:therapeutic use; D016896:Treatment Outcome; D019562:Viral Load
D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C100416:peginterferon alfa-2a