title: Post-liver transplant hepatitis C virus recurrence: an unresolved thorny problem.
abstract: Hepatitis C virus (HCV)-related cirrhosis represents the leading cause of liver transplantation in developed, Western and Eastern countries. Unfortunately, liver transplantation does not cure recipient HCV infection: reinfection universally occurs and disease progression is faster after liver transplant. In this review we focus on what happens throughout the peri-transplant phase and in the first 6-12 mo after transplantation: during this crucial period a completely new balance between HCV, liver graft, the recipient's immune response and anti-rejection therapy is achieved that will deeply affect subsequent outcomes. Nearly all patients show an early graft reinfection, with HCV viremia reaching and exceeding pre-transplant levels; in this setting, histological assessment is essential to differentiate recurrent hepatitis C from acute or chronic rejection; however, differentiating the two patterns remains difficult. The host immune response (mainly cellular mediated) appears to be crucial both in the control of HCV infection and in the genesis of rejection, and it is also strongly influenced by immunosuppressive treatment. At present no clear immunosuppressive strategy could be strongly recommended in HCV-positive recipients to prevent HCV recurrence, even immunotherapy appears to be ineffective. Nonetheless it seems reasonable that episodes of rejection and over-immunosuppression are more likely to enhance the risk of HCV recurrence through immunological mechanisms. Both complete prevention of rejection and optimization of immunosuppression should represent the main goals towards reducing the rate of graft HCV reinfection. In conclusion, post-transplant HCV recurrence remains an unresolved, thorny problem because many factors remain obscure and need to be better determined.
authors.affiliation: Alberto Grassi, Giorgio Ballardini, Internal Medicine and Hepatology Division, Department of Internal Medicine, "Infermi" Hospital, 47923 Rimini, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Grassi
authors.affiliation: Alberto Grassi, Giorgio Ballardini, Internal Medicine and Hepatology Division, Department of Internal Medicine, "Infermi" Hospital, 47923 Rimini, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Ballardini
mesh_terms: D000818:Animals; D000998:Antiviral Agents / Q000627:therapeutic use; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D006085:Graft Survival; D016174:Hepacivirus / Q000187:drug effects / Q000276:immunology / Q000472:pathogenicity*; D006526:Hepatitis C / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000235:genetics / Q000276:immunology / Q000821:virology*; D054884:Host-Pathogen Interactions; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D008103:Liver Cirrhosis / Q000601:surgery* / Q000821:virology; D016031:Liver Transplantation / Q000009:adverse effects*; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014775:Virus Activation / Q000187:drug effects
chemical_list: D000998:Antiviral Agents; D007166:Immunosuppressive Agents
keywords: Graft rejection; Hepatitis C antigens; Hepatitis C virus; Immunosuppression; Liver transplantation