title: Hepatitis C: liver transplantation.
abstract: Hepatitis C virus (HCV)-related cirrhosis and hepatocellular carcinoma account for approximately 40% of the 6,000 adult liver transplantations performed each year in the United States. Survival rates are 76% to 83% at 2 years and 69% to 72% at 5 years. If eligible for surgery and in the absence of contraindications, any patient with HCV infection who develops decompensated liver disease or hepatocellular carcinoma is a candidate for liver transplantation. Most transplantation programs require that a patient with a history of alcohol or drug abuse be abstinent for at least 6 months and active in a substance abuse rehabilitation program. Prioritization for transplantation is based primarily on a patient's model for end-stage liver disease score, though other factors are considered. Complications after liver transplantation include recurrence of HCV infection, rejection of the transplanted liver, and an increased rate of infection because of immunosuppression. Various drugs are used to prevent infection and organ rejection. Liver transplant recipients also develop diabetes, hypertension, hyperlipidemia, renal dysfunction, osteopenia, and cancers at high rates, likely because of the effects of immunosuppressive drugs, particularly steroids and calcineurin inhibitors. The family physician's role in caring for liver transplant recipients often involves detection and management of these conditions.
authors.affiliation: California Substance Abuse and Treatment Center, 900 Quebec Ave, Corcoran, CA 93212.
authors.forename: Julius
authors.initials: J
authors.lastname: Metts
authors.affiliation: California Correctional Health Care Services, P.O. Box 588500, Elk Grove, CA 95758, Lesley.Carmichael@cdcr.ca.gov.
authors.forename: Lesley
authors.initials: L
authors.lastname: Carmichael
authors.affiliation: California Substance Abuse Treatment Facility and State Prison, 900 Quebec Ave, Corcoran, CA 93212.
authors.forename: Winfred
authors.initials: W
authors.lastname: Kokor
authors.affiliation: California Substance Abuse and Treatment Center, 900 Quebec Ave, Corcoran, CA 93212.
authors.forename: Robert
authors.initials: R
authors.lastname: Scharffenberg