Management of recurrent hepatitis C in liver transplant recipients

Infectious Disease Clinics of North America
Scott W Biggins, Norah A Terrault

Abstract

Recurrent HCV infection is universal in liver transplant recipients who are viremic pretransplant. The rate of histologic disease progression after transplantation is more rapid, and the risk of cirrhosis by 5 to 10 years is about 30%. Several donor, recipient, and viral factors have been associated with worse post-transplant outcomes in recipients with recurrent hepatitis C. Whether or not HCV-infected recipients of live donor grafts have worse out-comes compared with deceased donor graft recipients is controversial. To maximize the long-term survival of recipients with HCV infection, eradication of infection is the ultimate goal. Treatment of recurrent HCV after liver transplantation can be undertaken at several different time points: (1) prophylactically, at the time of transplantation; (2) pre-emptively, in the early post-transplant period; and (3) after established recurrent histologic disease is present. Prophylactic therapy for HCV infection has no established role at present, but studies are ongoing. Preemptive therapy using IFN and RBV has resulted in variable SVR rates (9%-43%) and is generally poorly tolerated, especially if the patient has advanced liver disease pretransplantation. Treatment of established recurrent...Continue Reading

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Citations

Nov 26, 2009·Expert Review of Gastroenterology & Hepatology·Bruce Gelb, Sandy Feng
Nov 6, 2007·Expert Opinion on Emerging Drugs·Jan ter Meulen
Dec 29, 2007·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·Ibrahim A HanounehNizar N Zein

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