[Liver transplantation in patients with chronic viral hepatitis]

Liver transplantation (LT) for end-stage liver disease secondary to hepatitis viruses has evolved rapidly during the last two decades. Currently, due to significant improvements in immunosuppressive therapy and surgical techniques, excellent survival rates and quality of life can be achieved. Among several circumstances that may pose a threat to long-term survival, the greatest is likely the recurrence of the original liver disease. Recurrence of viral infection and hepatitis is a common problem for patients undergoing LT for hepatitis B or hepatitis C. In the early 1980s, results of LT for chronic hepatitis B virus (HBV) infection were hampered by recurrent infection and subsequent allograft failure. However, following the introduction of passive immunoprophylaxis with hepatitis B immunoglobulin (HBIg) and treatment with potent oral nucleoside analogs, there has been a resurgence in the interest for this indication. HCV-related end-stage liver disease virus accounts for approximately 50% of LT in the United States and Europe. Despite the decrease in the number of new HCV infections, the prevalence of advanced HCV-related liver disease is steadily increasing. In light of the near universal recurrence of posttransplantation HCV infection and our limited ability to treat recurrent disease, transplantation is in danger of being overrun by viral hepatitis, unless effective strategies can be used to treat disease. This review summarizes available data and highlights appropriate strategies to improve outcomes.