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Published on: February 19, 2019
Hepatitis C infection in transplantation
1Division of Gastroenterology, University of California San Francisco, San Francisco, California, USA.
Insights
Hepatitis C virus (HCV) recurrence is common after liver transplants, but its long-term impact on survival remains unclear. Further research is needed to identify factors influencing disease progression and develop effective therapies.
Area of Science:
- Hepatology
- Transplant Medicine
- Virology
Background:
- Hepatitis C virus (HCV) infection is a leading cause of end-stage liver disease and a common indication for liver transplantation.
- HCV recurrence post-transplantation is nearly universal in patients with pre-transplant viremia.
- Acquired HCV infection, though less common, is significant in populations with inadequate screening.
Purpose of the Study:
- To review the role and impact of HCV in the transplant setting.
- To analyze the natural history and outcomes of HCV infection after various solid organ and bone marrow transplantation.
- To highlight knowledge gaps and future research directions regarding HCV in transplant recipients.
Main Methods:
- Review of existing literature on HCV infection in liver, kidney, heart, lung, and bone marrow transplant recipients.
- Analysis of data regarding HCV recurrence, disease progression, and impact on graft and patient survival.
- Identification of factors influencing post-transplant HCV disease severity and outcomes.
Main Results:
- HCV recurrence is almost universal after liver transplantation in viremic patients.
- Post-transplant HCV infection may increase the risk of liver disease and complications, but its effect on survival is controversial and appears minor in short-term follow-up (5-10 years).
- Kidney, heart, lung, and bone marrow transplant recipients with HCV generally do not experience major mortality from the infection within the first decade post-transplant.
Conclusions:
- While HCV recurrence is common, its long-term impact on graft and patient survival after transplantation requires further investigation.
- Identifying factors contributing to disease progression and developing effective eradication therapies are critical unmet needs.
- More extensive long-term follow-up and detailed studies are essential to fully understand HCV's role in transplant outcomes.
Abstract:
This review emphasizes the role of HCV in the transplant setting. Prolonged HCV infection results in end-stage liver disease and as such represents a common indication for liver transplantation. Recurrence of infection is almost universal after transplantation in those with viremia before transplantation. Acquired disease is uncommon but nevertheless important, particularly in organ populations in whom screening for infection is not routine. The natural history of post-transplantation disease suggests that the effect on graft or patient survival is minor, at least during short-term follow-up. Long-term follow-up is needed, as well as more detailed study of the factors contributing to severity of post-transplantation disease. Kidney transplant recipients are commonly infected with HCV prior to transplantation. HCV infection after transplantation is associated with an increased risk of liver disease and infectious complications, but its effect on survival is still controversial. Similarly, observations in recipients of other solid organ transplants, such as heart and lung, and bone marrow patients suggest that HCV infection usually is not a major cause of mortality in the first 5 to 10 years of follow-up. Many issues still need to be addressed. The most important is the identification of factors that contribute to disease progression. Finally, effective therapies to eradicate infection and prevent disease progression are awaited.
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