Posttransplantation recurrence of hepatitis C virus infection is a universal phenomenon with a highly variable natural history. 2. Approximately 10% to 25% of hepatitis C virusinfected recipients of liver allografts will develop cirrhosis within 5 years' after transplantation. 3. The 1-year actuarial risk of hepatic decompensation after recurrence of cirrhosis approximates 42%. 4. Some of the factors associated with aggressive recurrence include donor and recipient age, recent year of transplantation, recipient gender and race, the use of antithymocyte globulin, and high dose of corticosteroids. 5. Highly aggressive recurrent hepatitis C virus infection leading to cirrhosis fares poorly after retransplantation in the presence of hyperbilirubinemia and renal failure, with a 1-year survival of approximately 40%. 6. Elevated serum aminotransferases are a poor indicator or recurrent disease. 7. Current sustained virological response after combination pegylated alpha interferon and ribavirin treatment is approximately 25%. 8. There is no consensus on initiation time point, duration of treatment, or dosage. Given immunosuppression, at least 48 weeks of therapy is a reasonable approach. 9. Treatment for 48 weeks is cost effective. Incremental cost-effectiveness ratio for men aged 55 years is $29,100 per life-year saved.
C hronic hepatitis C virus (HCV) infection is com- mon and affects a significant proportion of the world population, with an estimated 170 million people infected and 3 to 4 million new cases per year. 1,2 HCV-related cirrhosis is the most common indication for liver transplantation (LT) in the United States and most European countries. [3][4][5][6][7] In the United States, over one-third of available liver allografts are transplanted into recipients with chronic HCV infection. In fact, despite a decline in the incidence of new HCV cases, the prevalence of infection will not peak until the year 2040. 5 As the duration of infection increases, the number of new patients with cirrhosis will double by the year 2020 in an untreated patient population. 5 If this model is correct, the projected increase in the need for LT secondary to chronic HCV infection will place a burden that may be impossible to meet on an already limited supply of organ donors.
In this article, we review the natural history of HCV in the transplantation population, risk factors associ-ated with severity of recurrence, histological changes associated with recurrence of disease, treatment strategies, and the role of retransplantation.