title: Recurrent hepatitis C after liver transplant.
abstract: End stage liver disease from hepatitis C is the most common indication for liver transplantation in many parts of the world accounting for up to 40% of liver transplants. Antiviral therapy either before or after liver transplantation is challenging due to side effects and lower efficacy in patients with cirrhosis and liver transplant recipients, as well as from drug interactions with immunosuppressants. Factors that may affect recurrent hepatitis C include donor age, immunosuppression, IL28B genotype, cytomegalovirus infection, and metabolic syndrome. Older donor age has persistently been shown to have the greatest impact on recurrent hepatitis C. After liver transplantation, distinguishing recurrent hepatitis C from acute cellular rejection may be difficult, although the development of molecular markers may help in making the correct diagnosis. The advent of interferon free regimens with direct acting antiviral agents that include NS3/4A protease inhibitors, NS5B polymerase inhibitors and NS5A inhibitors holds great promise in improving outcomes for liver transplant candidates and recipients.
authors.affiliation: Andrew S deLemos, Paul A Schmeltzer, Mark W Russo, Department of Medicine, Center for Liver Diseases and Transplantation, Carolinas Medical Center, Charlotte, NC 28232-2861, United States.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: deLemos
authors.affiliation: Andrew S deLemos, Paul A Schmeltzer, Mark W Russo, Department of Medicine, Center for Liver Diseases and Transplantation, Carolinas Medical Center, Charlotte, NC 28232-2861, United States.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Schmeltzer
authors.affiliation: Andrew S deLemos, Paul A Schmeltzer, Mark W Russo, Department of Medicine, Center for Liver Diseases and Transplantation, Carolinas Medical Center, Charlotte, NC 28232-2861, United States.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Russo
mesh_terms: D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001706:Biopsy; D058625:End Stage Liver Disease / Q000175:diagnosis / Q000601:surgery* / Q000821:virology; D016174:Hepacivirus / Q000187:drug effects* / Q000472:pathogenicity; D006526:Hepatitis C / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000821:virology; D054884:Host-Pathogen Interactions; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000601:surgery* / Q000821:virology; D016031:Liver Transplantation / Q000009:adverse effects*; D011237:Predictive Value of Tests; D012008:Recurrence; D012086:Reoperation; D012307:Risk Factors; D016896:Treatment Outcome; D014775:Virus Activation / Q000187:drug effects*
chemical_list: D000998:Antiviral Agents; D007166:Immunosuppressive Agents
keywords: Acute cellular rejection; Cytomegalovirus; Donor risk factors; Fibrosing cholestatic hepatitis C; Hepatitis C; Immunosuppression; Liver transplant; Protease inhibitors