Factors that influence the severity of recurrent hepatitis C virus following liver transplantation

Poor outcomes following OLT for HCV disease have been associated with several host, viral, and non-host/non-viral factors. As is evident from the literature, there is confounding data in favor of and against these factors in the pathogenesis of severe recurrent HCV. Nevertheless, from a viral perspective, the patient most likely to achieve a good outcome following OLT is someone with low-level (< or = 10(9) copies/mL) HCV RNA viremia both pre- and post-OLT and a genotype other than lb. In terms of host factors, the patients with best outcomes are: whites, men, less than 49 years of age, receiving a donor liver less than 40 years of age, not coinfected with CMV, and have low HAI or histologic activity indices during the early stage of follow-up. Host recipient immune homology may or may not be a major factor in outcomes. A non-host, non-viral factor favoring less severe recurrence of HCV is a shorter warm ischemia time. Finally, features that may influence outcomes over which there is no control include: recipient age, recipient gender, and donor age (in the case of cadaveric donors). Unfortunately, the best-case scenario is uncommon.