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Natural History of Chronic HCV After Liver Transplantation

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Chronic Hepatitis C Virus

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Abstract

Hepatitis C-associated liver disease is the most common indication for liver transplantation. Virological recurrence is ubiquitous. While the histological impact of recurrence varies substantially between recipients, approximately 30% of HCV-infected recipients will die or lose their allograft or develop cirrhosis secondary to hepatitis C recurrence by the fifth postoperative year. Viral, recipient, and donor factors affect the likelihood if more severe recurrence. Recipient and donor age, utilization of posttransplant antiviral therapy, higher pre- and posttransplant levels of HCV viremia, corticosteroid boluses for acute cellular rejection, Cytomegalovirus (CMV) disease, metabolic syndrome, HIV coinfection, and non-CC IL28B genotype all are associated with more severe recurrence. Strategies for minimizing the frequency of severe HCV recurrence are evolving and include avoidance of older donors, early diagnosis/treatment of CMV, and minimization of immunosuppression and avoidance of pulsed corticosteroid treatment of acute cellular rejection. Patients should be offered treatment with peginterferon and ribavirin as soon as histological evidence of recurrence of HCV is apparent.

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands

    Bart J. Veldt MD

  2. Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Michael R. Charlton MD, MBBS

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Correspondence to Michael R. Charlton MD, MBBS .

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  1. Bon Secours Health System, Liver Institute of Virginia, McManus Blvd., Suite 313 12720, Newport News, 23602, Virginia, USA

    Mitchell L. Shiffman

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Veldt, B.J., Charlton, M.R. (2012). Natural History of Chronic HCV After Liver Transplantation. In: Shiffman, M. (eds) Chronic Hepatitis C Virus. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-1192-5_22

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  • DOI: https://doi.org/10.1007/978-1-4614-1192-5_22

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