Treatment of HCV recurrence: Do the pretransplantation rules apply?

✍ Scribed by James R. Burton Jr.; Hugo R. Rosen

• Publisher: John Wiley and Sons
• Year: 2006
• Tongue: English
• Weight: 82 KB
• Volume: 12
• Category: Article
• ISSN: 1527-6465
• DOI: 10.1002/lt.20783

✦ Synopsis

Hepatitis C virus (HCV)-induced liver disease is the leading indication for liver transplantation in the Western world, and recurrent infection occurs universally. Recurrence of HCV is a major problem for the transplant physician, as recurrent HCV infection appears to significantly impact posttransplantation survival. 1 Although nearly all patients develop some evidence of histologic recurrence, the natural history of recurrent HCV is highly variable and poorly understood. Approximately one-third will develop minimal fibrosis after 5 yrs of follow-up, 2 yet for others the natural history is accelerated, with 20 to 40% developing allograft cirrhosis after 5 yrs, compared to 3 to 20% at 20 yrs in the nontransplant setting. [3][4][5][6] In addition, it appears that rates of fibrosis progression appear to be increasing, 7,8 and once cirrhosis develops, rates of decompensation and death are high. 6 Given the impact the natural history of HCV recurrence has on graft and patient survival, several treatment strategies have been utilized to prevent or slow the progression to HCV-related graft failure. These include antiviral therapy prior to transplantation, prophylactic therapy starting at the time of transplantation to prevent allograft reinfection, preemptive therapy initiated in the early posttransplantation period before the development of clinically apparent acute hepatitis, and posttransplantation therapy at time of diagnosis of acute hepatitis or for established severe and/or progressive chronic hepatitis. A fundamental, yet unanswered, question is whether what we know regarding the treatment of the pretransplant patient translates into relevant guidelines following transplantation (Ta-