[Recurrent disease after liver transplantation. A therapeutic dilemma or treatable?].
BACKGROUND
Side effects of immunosuppressive drugs, the development of de novo malignancies and disease relapse determine the prognosis of liver transplant patients in the long-term course.
Treatment of carefully selected and monitored hepatitis C liver transplant patients with interferon-alpha and ribavirin is safe but less efficacious as compared to the non-transplant setting. Postoperative hepatitis B hyperimmune globulin and nucleoside analog combination therapy has resulted in a decrease of reinfection rates to < 10%. New molecular techniques as well as genotyping of hepatocellular carcinoma gain increasing importance for estimation of recurrence-free survival. Diagnosis of disease relapse in cholestatic and autoimmune liver disease is more challenging than in the non-transplant setting and therapeutic options are limited. Psychiatric evaluation and careful validation of compliance are important issues for estimation of the risk of disease recurrence in patients with alcohol-related liver disease. During long-term course, up to one half of patients die of transplant-related causes; 30-70% of these cases are attributed to relapse of primary disease.


CONCLUSIONS
Further improvement of strategies for prevention and treatment of recurrent disease after liver transplantation is warranted in order to increase long-term survival.
Beckebaum
Susanne
S
Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Essen, Essen, Deutschland. susanne.beckebaum@uni-due.de
Cicinnati
Vito R
VR
Broelsch
Christoph E
CE
Gerken
Guido
G
D000367:Age Factors; D000998:Antiviral Agents / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000628:therapy; D002780:Cholestasis, Intrahepatic / Q000628:therapy; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006509:Hepatitis B / Q000188:drug therapy; D006526:Hepatitis C / Q000188:drug therapy; D019693:Hepatitis, Autoimmune / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D015994:Incidence; D016898:Interferon-alpha / Q000627:therapeutic use; D008107:Liver Diseases / Q000209:etiology* / Q000517:prevention & control / Q000628:therapy*; D008108:Liver Diseases, Alcoholic / Q000628:therapy; D008113:Liver Neoplasms / Q000628:therapy; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008875:Middle Aged; D010349:Patient Compliance; D011379:Prognosis; D012008:Recurrence; D012254:Ribavirin / Q000627:therapeutic use; D012307:Risk Factors; D013997:Time Factors
D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D016898:Interferon-alpha; D012254:Ribavirin