Posttransplantation prevention and treatment of recurrent hepatitis C

Hepatitic C virus (HCV) viremia is universal after orthotopic liver transplantation (OLT) for HCV cirrhosis. 2. At 5 years post-OLT, approximately 20% of patients have cirrhosis caused by recurrent hepatitis C. 3. Progression of disease is related to immunosuppression, immune response (CD4(+) lymphocytes), HCV genotype, and HCV quasispecies homogeneity. 4. Whether a therapeutic strategy of pre-OLT or early (preemptive) antiviral therapy is better than treating a clinically important hepatitis and the duration of treatment are not known. 5. Monotherapy with recombinant interferon-alpha or ribavirin is not useful in the long term. 6. Combination therapy (interferon and ribavirin) has given better results, but long-term data are not available. 7. HCV recurrence will benefit from randomized studies.