Management of recurrent hepatitis C after liver transplantation

Hepatitis C virus (HCV) reinfection is almost universal in patients transpl anted for HCV-related cirrhosis. The medium-term survival after orthotopic liver transplantation (OLT) is similar to other transplanted patients, but the long-term survival remains uncertain. The prevention and an effective t reatment of progressive liver disease are the primary aims in HCV recurrenc e. Interferon and ribavirin, as monotherapy or in combination, have been tr ied to treat or prevent HCV recurrence. Preliminary studies suggest a bette r chance of initial HCV clearance and better results in preventing HCV recu rrence with combination therapy. IFN or ribavirin, as monotherapy, may norm alize liver enzymes, but only gives rise to a transient virological respons e, without histological improvement. Combination IFN and ribavirin may be a ble to prevent progression of HCV-related graft disease, but indications an d duration of treatment need further evaluation. No clear association between type and dose of immunosuppressive and outcome of post-transplant HCV recurrence has been found. Strategies to minimize t he effects of immunosuppressive drugs include dose reduction of all agents and the selective discontinuation of individual agents. Initial immunosuppr ession with a single drug may inhibit or delay the severe fibrosis, and fur ther investigation with a single immunosuppressive regimen to evaluate the outcome of recurrent hepatitis C should be performed. The recent evidence t hat mycophenolate may have an antiviral effect needs a clinical confirmatio n. Retransplantation survival is better with early retransplantation, and for indications not directly related to viral recurrence.