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Natural history of hepatitis C and outcomes following liver transplantation
1Division of Transplantation Medicine, Mayo Clinic, Scottsdale, AZ, USA.
Insights
Hepatitis C virus (HCV) recurrence after liver transplantation (LT) is common, leading to graft cirrhosis and poor survival. Management strategies are crucial for improving outcomes in these complex patients.
Area of Science:
- Hepatology
- Transplantation Medicine
- Virology
Background:
- Chronic hepatitis C virus (HCV) infection is a leading cause of liver cirrhosis and liver transplantation (LT).
- HCV recurrence post-LT is nearly universal, significantly impacting graft survival and patient outcomes.
- Graft cirrhosis develops in up to 30% of recipients within 5 years, with high rates of decompensation and mortality.
Purpose of the Study:
- To provide an up-to-date review of liver transplantation in the context of HCV infection and cirrhosis.
- To outline the natural history, recurrence patterns, and risk factors for recurrent HCV disease post-LT.
- To discuss current treatment strategies, the role of re-transplantation, and de-novo hepatocellular carcinoma.
Main Methods:
- Literature review of studies on liver transplantation for HCV infection.
- Analysis of data on HCV recurrence rates, progression to cirrhosis, and survival outcomes.
- Synthesis of information on risk factors, treatment options, and re-transplantation in HCV-infected LT recipients.
Main Results:
- HCV recurrence post-LT is a significant challenge, with high rates of graft cirrhosis and accelerated disease progression.
- Decompensation occurs in a substantial proportion of patients within 3 years, leading to poor survival rates.
- A notable percentage of patients require re-transplantation due to recurrent HCV disease.
Conclusions:
- Effective management of recurrent HCV infection post-LT is critical for improving long-term graft and patient survival.
- Understanding risk factors and implementing timely treatment strategies are essential.
- Further research into novel therapeutic approaches and preventative measures is warranted.
Abstract:
Chronic hepatitis C virus (HCV) infection is common and affects a significant proportion of the population. Chronic HCV-related cirrhosis is the most common indication for liver transplantation (LT) in Australia, the United States (US), and most European countries. Unfortunately, the post-transplant recurrence of HCV is almost a universal phenomenon with approximately 6% to 23% of transplant recipients progressing to cirrhosis at a median of 3 to 4 years post-LT with a cumulative probability of developing graft cirrhosis estimated to reach 30% at 5 years. The 1-year and 3-year actuarial risk of decompensation has been estimated at 42% and 62%, respectively. Similarly, the rate of progression from hepatic decompensation to death is accelerated after LT with a 3-year survival rate of less than 10% in decompensated HCV liver recipients. Ten percent to 25% of the patients with recurrent disease will require re-transplantation within 5 years. Because of the increasing number of patients transplanted for chronic HCV infection and the complexity of factors affecting this population we will present an up-to-date review concerning LT in the setting of HCV infection and cirrhosis with the goal of outlining the natural history, recurrence of infection, risk factors associated with severity of recurrence, treatment strategies for recurrent HCV infection, role of re-transplantation, and de-novo hepatocellular carcinoma.
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