Antiviral treatment of recurrent hepatitis C after liver transplantation: The need for a multifaceted approach

✍ Scribed by Didier Samuel

• Publisher: John Wiley and Sons
• Year: 2005
• Tongue: English
• Weight: 56 KB
• Volume: 41
• Category: Article
• ISSN: 0270-9139
• DOI: 10.1002/hep.20623

✦ Synopsis

H

epatitis C virus (HCV)-related cirrhosis is currently the leading indication for liver transplantation in Europe and in the United States. 1,2 HCV recurrence after transplantation is almost universal, and 60%-90% of patients will develop lesions of chronic hepatitis C on the graft. 3 The course of HCV graft disease is accelerated in transplant recipients compared with immune-competent patients, with reported incidence rates of cirrhosis at 5 years of approximately 10%-30%. [3][4][5] This results in an excess risk of death or retransplantation for liver failure at 10 to 15 years posttransplantation. 2,6 The reasons for this accelerated course are incompletely understood. Several factors are involved: viral-related (genotype, amount of virus, quasispecies selection), immunological in nature (immunosuppression, quality and intensity of immune response), as well as related to the transplant itself (quality of the graft, age of the donor). Two main types of chronic graft lesions have been described. The first, named "fibrosing cholestatic hepatitis" (FCH), is rare and severe. FCH usually occurs during the first posttransplantation year, represents 10% of the cases of posttransplantation hepatitis, and is characterized by the association of jaundice and liver failure. 7 FCH appears to arise from the inability of the immune system of the recipient to clear HCV from the liver, leading to a very high HCV load in the graft associated with a stable HCV quasispecies. 8 It has therefore been suggested that in this particular context, HCV becomes cytopathic. 7 Otherwise, the course is more classical, but much more rapid than in immunocompetent patients. Acute hepatitis occurs between 1 and 4 months posttransplantation followed by a chronic course. It has been shown that administration of steroids increases the viral load, and Abbreviations: HCV, hepatitis C virus; FCH, fibrosing cholestatic hepatitis; SVR, sustained virological response.