Course and treatment of recurrent Hepatitis C after liver transplantation

Hepatitis C virus (HCV) related liver cirrhosis is the most common indication for orthotopic liver transplantation (OLT) in most transplant centers. However, recurrence of hepatitis C-infection after OLT in HCV positive patients is almost universal. Severity of graft hepatitis increases during the long term follow-up and up to 30% of patients develop severe graft hepatitis and cirrhosis. This led to decreased patient and graft survival in HCV positive patients. A number of variables like genotype, donor age, rejection treatment, cytomegalo-virus disease and liver retransplantation for HCV recurrence have shown to be associated with early and severe graft hepatitis. Prophylactic or therapeutic regimens which alter the course of disease in HCV positive patients are not established yet, and with longer follow-up the prevalence of HCV-related graft failure is likely to increase. New immunosuppressive regimens and anti-viral treatment with ribavarin in combination with pegylated interferon a have to be investigated to reduce the complications of HCV recurrence in the future.