[Post-transplant hepatitis C. Immunosuppression and antiviral treatment]

There is always a second infection with HCV during the post-transplant period. Recurrence of the disease is one of the main present therapeutic challenges because there are still many questions to answer. Some transplant groups suggest that recurrence is earlier in certain circumstances, especially in face of repetitive episodes of acute rejection in the early post-transplant period. Different transplant centers have various approaches to minimize the risk of recurrence secondary to excessive immunosuppression. They go from absolute avoidance of steroids to single therapy with inhibitors of calcineurin. Some investigators advocate for a fast reduction in the dose of corticosteroids (in less than 3 months), elimination of steroids from the therapy or administration of a single steroid dose in the immediate post-transplant period. Some are trying to establish a regime based on a single inhibitor of calcineurin and supported with mofetil micofenolate if it's effective. There are other inhibitors being studied, like anti-CD25 antibodies. The goals of the treatment for HCV recurrence must be aimed at obtaining an effective therapy that may be able to prevent the damage and to inhibit the viral replication and subsequent inflammation on long term basis. Recently there have been reports about different schemes with IFN and ribavirin, either as single therapy or in combination, that showed modest advances in early viral elimination and delaying the recurrence of the disease. One of the risks of therapy with interferon that has immunomodulation properties, is organ rejection. Ribavirin administration as single therapy is contraindicated. There are still some unanswered questions, since nobody knows for sure how long therapy for HCV should be continued.