MORBIDITY AND MORTALITY OF RECURRENT HEPATITIS-C INFECTION AFTER ORTHOTOPIC LIVER-TRANSPLANTATION

Through molecular virological testing it is now clear that HCV reinfec tion of the allograft is virtually universal in liver transplant recip ients, Although histopathological recurrence of hepatitis C occurs in the majority of patients, it is absent in a substantial minority. To d ate, no prognostic factors, other than genotype 1 b, have been identif ied that accurately predict these dissimilar outcomes. The natural his tory of recurrent hepatitis C varies, Historically, it has been regard ed as generally benign, However, with increasing numbers of patients t ransplanted for hepatitis C it is now clear that a subgroup of patient s develops severe progressive cholestatic hepatitis associated with al lograft failure and death without retransplantation. Within 5 years fo llowing OLT, approximately 15-20% of patients progress to chronic acti ve hepatitis and another 15-20% become cirrhotic. A minority of patien ts develop glomerulopathy or vasculitis, which are often associated wi th cryoglobulinaemia. The impact of immunosuppressive medications and rejection episodes on histopathological recurrence of progressive hepa titis C remains controversial and requires further studies, Although a ctuarial survival rates of patients transplanted for hepatitis C diffe r among transplantation centres, it appears that histopathological rec urrence of hepatitis C does have an adverse impact on actuarial surviv al compared to the survival of patients transplanted for autoimmune he patitis, primary biliary cirrhosis, primary sclerosing cholangitis and metabolic liver diseases, When allograft failure develops in patients with recurrent hepatitis C, retransplantation is indicated, even thou gh recent reports indicate that mortality may be increased, especially with concurrent renal insufficiency.