[HCV reinfection after liver transplantation for HCV cirrhosis].
Cirrhosis due to hepatitis C virus (HCV) infection is now the most frequent indication for orthotopic liver transplantation (OLT). Recurrence of hepatitis C infection is the major cause of late mortality in patients undergoing OLT for hepatitis C cirrhosis. Recurrent HCV infection develops in 100% of patients HCV + in pre-transplantation time. Histological recurrence occurs in 75-80% of patients after OLT:1/3 of them progress to allograft cirrhosis within 5-7 years. Cholestatic hepatitis C develops in a sub-group of patients who progresses rapidly to graft failure. As a result of this accelerated course of HCV infection, long-term graft and patient survival are significantly reduced in patients undergoing OLT for HCV-related cirrhosis compared with other groups. Moreover, several recurrence's risk factors have been described as predictors of disease severity including those related to the virus, the host, the donor. There are numerous therapeutic strategies to prevent and to treat HCV disease recurrence after OLT. The most common strategy to treat HCV infection post-OLT is based on interferons and ribavirin. Even if clinical trials have shown that the combination of ribavirin with Peg-interferons is more effective than its association with standard interferons, the use of Peg-interferons in transplanted patients is limited by the side-effects of the drug. About treatment of hepatitis C virus infection in the allograft dark and not still cleared points are a lot: the timing and the target of therapy, the dose and duration of pharmacological treatment.
Pasquale
G
G
Dipartimento di Medicina Pubblica, Clinica e Preventiva, Sezione Malattie Infettive, Seconda Universita degli Studi di Napoli, Italy.
Iannicelli
P
P
Martini
S
S
Mogavero
A R
AR
Caprio
N
N
D000998:Antiviral Agents / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D016174:Hepacivirus; D006526:Hepatitis C / Q000150:complications* / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D007372:Interferons / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000601:surgery* / Q000821:virology*; D016031:Liver Transplantation; D012254:Ribavirin / Q000627:therapeutic use; D016896:Treatment Outcome
D000998:Antiviral Agents; D012254:Ribavirin; D007372:Interferons