Liver transplantation in viral hepatitis: prevention of recurrence.
End-stage liver disease caused by the hepatitis B and C viruses (HBV and HCV) are major indications for liver transplantation. Outcome depends largely on the prevention of allograft reinfection. The advent of long-term hepatitis B immune globulin administration and the introduction of new antiviral agents were a major breakthrough in the management of these patients. Today, survival after orthotopic liver transplantation (OLT) is similar to that of patients transplanted for HBsAg-negative liver disease, and the risk of recurrence is below 10%. In contrast, HCV reinfection is almost constant and significantly impairs patient and graft survival. Factors that may influence disease severity and consequently progression of HCV graft injury remain unclear. Pre-transplantation and prophylactic post-transplantation antiviral treatments are limited by low applicability and poor tolerance. Treatment of established graft lesions with combination therapy gave promising results, with sustained virological response in 25-45% of patients, but indications, modality and duration of treatment should be assessed.
Roche
Bruno
B
Assistance Publique-Hopitaux de Paris, Hopital Paul Brousse, Centre Hepato-Biliaire, Villejuif, France.
Samuel
Didier
D
D000998:Antiviral Agents / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D004359:Drug Therapy, Combination; D006509:Hepatitis B / Q000188:drug therapy / Q000601:surgery*; D006526:Hepatitis C / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D007116:Immunization, Passive; D007136:Immunoglobulins / Q000627:therapeutic use; D007155:Immunologic Factors / Q000627:therapeutic use; D016031:Liver Transplantation; D011182:Postoperative Care / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D055502:Secondary Prevention; D016896:Treatment Outcome
D000998:Antiviral Agents; D007136:Immunoglobulins; D007155:Immunologic Factors