[Recurrence and management of hepatitis C after liver transplantation]

End-stage liver disease caused by viral hepatitis C has been increasing recently in Korea. In this study, we investigated the clinical progress, recurrence, and management of hepatitis C patients who underwent liver transplantation.

We retrospectively reviewed the clinical progress and management of 16 patients (2.7%) with hepatitis C among 587 liver transplant patients from August 1992 to August 2002.

Eleven cases among 16 patients were males. The median age was 56 +/- 6 (42-62) years and the median follow-up period was 6 +/- 13 (1-41) months. Thirteen cases underwent living donor liver transplantation and three had cadaveric whole liver transplantation. Clinical recurrence occurred in nine cases (56.3%) and mean time of recurrence was 5.2 months. Histological recurrence cases were eight (50%). A positive result of HCV RNA PCR was found in 90.9%, and all cases of clinical and histological recurrence in groups in the same periods were PCR-positive. Among eight cases showing histological recurrence, five patients were managed by ribavirin monotherapy, two patients received interferon and ribavirin combination therapy, and one patient was not treated at all. The serum aminotransferase level was normalized in six cases (75%) of them.

We observed that the HCV reinfection rate of a transplanted liver was high in this study, as in other reports in the literature. The prevention of HCV recurrence and the management of post-recurrent cirrhotic change are crucial for graft and patient survival. We think customized protocols are needed for every situation of recurrent hepatitis C.