Natural history of hepatitis C following liver transplantation

Hector Rodriguez-Luna, David D. Douglas

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Purpose of review: Currently, chronic hepatitis C virus-infection-related cirrhosis is the most common indication for liver transplantation in the USA and most parts of the world. While the incidence of new hepatitis C virus cases has decreased, the prevalence of infection will not peak until the year 2040. In addition, as the duration of infection increases, the proportion of new patients with cirrhosis will double by 2020 in an untreated patient population. If this model is correct, the projected increase in the need for liver transplantation secondary to chronic hepatitis C virus infection will place an impossible burden on an already limited supply of organs. In this article we present a comprehensive review of post-transplant hepatitis C virus infection and address the major challenges that face the transplant community. Recent findings: Hepatitis C virus infection recurs virtually in every post-transplant patient. Typically, serum levels of hepatitis C virus RNA increase rapidly from week 2 post-liver transplant, achieving 1-year post-liver transplant levels that are 10-20-fold greater than the mean pre-liver transplant levels. Progression of chronic hepatitis C virus is more aggressive after liver transplantation with a cumulative probability of developing graft cirrhosis estimated to reach 30% at 5 years. Approximately 10% of the patients with recurrent disease will die or require retransplantation within 5 years post-transplantation. Interventions to prevent, improve, or halt the recurrence of hepatitis C virus infection have been evaluated by multiple small studies worldwide with similar overall rates of virological clearance of approximately 9-30%. Current consensus recommends combination therapy with pegylated interferon and ribavirin for those patients with histological recurrence of hepatitis C virus infection and fibrosis of ≥2/4. Therapy is adjusted to tolerance and rescued with granulocyte colony-stimulating factor and erythropoietin for bone marrow suppression. Summary: The major challenges that face the transplant community in the coming years include new strategies to meet the growing demand for limited organ donor supplies and improvement of treatment for those patients in whom recurrence of viral disease has occurred. Only with improved antiviral treatments and strategies will we make a significant impact on this problem.

Original languageEnglish (US)
Pages (from-to)363-371
Number of pages9
JournalCurrent Opinion in Infectious Diseases
Volume17
Issue number4
DOIs
StatePublished - Aug 2004

Fingerprint

Hepatitis C
Hepacivirus
Liver Transplantation
Virus Diseases
Transplants
Facial Transplantation
Fibrosis
Chronic Hepatitis C
Recurrence
Liver
Ribavirin
Granulocyte Colony-Stimulating Factor
Therapeutics
Erythropoietin
Infection
Interferons
Antiviral Agents
Transplantation
Bone Marrow
Tissue Donors

Keywords

  • Acute cellular rejection
  • Fibrosing cholestatic hepatitis
  • Hepatitis C
  • Hepatocellular carcinoma
  • Interferon
  • Liver transplantation
  • Living-donor liver transplant
  • Ribavirin
  • Selective serotonin re-uptake inhibitor
  • Sustained viral response

ASJC Scopus subject areas

  • Microbiology (medical)
  • Immunology

Cite this

Natural history of hepatitis C following liver transplantation. / Rodriguez-Luna, Hector; Douglas, David D.

In: Current Opinion in Infectious Diseases, Vol. 17, No. 4, 08.2004, p. 363-371.

Research output: Contribution to journalArticle

Rodriguez-Luna, Hector ; Douglas, David D. / Natural history of hepatitis C following liver transplantation. In: Current Opinion in Infectious Diseases. 2004 ; Vol. 17, No. 4. pp. 363-371.
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