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Liver transplantation for hepatitis C
Shigeru Marubashi1, Keizo Dono, Atsushi Miyamoto
1Department of Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
Insights
Hepatitis C virus (HCV) recurrence post-liver transplant is common. Steroid-free immunosuppression combined with preemptive interferon and ribavirin therapy may prevent HCV recurrence in liver transplant recipients.
Area of Science:
- Hepatology
- Transplant Surgery
- Virology
Background:
- Hepatitis C virus (HCV) infection is a primary cause of end-stage liver disease globally.
- HCV recurrence post-liver transplantation affects nearly all patients, leading to graft cirrhosis in 30% within 5 years.
- Optimal immunosuppression strategies to prevent accelerated HCV progression in transplant recipients remain unclear.
Purpose of the Study:
- To evaluate the effectiveness of a steroid-free immunosuppression protocol combined with preemptive antiviral therapy for preventing Hepatitis C virus recurrence after liver transplantation.
- To describe the experience with living-donor liver transplantation for Hepatitis C patients at Osaka University.
Main Methods:
- Review of international transplant center reports on Hepatitis C virus management post-liver transplantation.
- Implementation of a steroid-free immunosuppression regimen.
- Preemptive combination therapy using low-dose interferon and ribavirin.
Main Results:
- Steroid-free immunosuppression and preemptive interferon/ribavirin therapy are considered the best strategy for managing Hepatitis C virus infection in liver transplant recipients.
- Experience at Osaka University with living-donor liver transplantation for Hepatitis C patients is presented.
Conclusions:
- A standardized approach to managing Hepatitis C virus infection in liver transplant recipients is necessary.
- Collaborative efforts among international liver transplant centers are crucial for standardizing treatment protocols.
Abstract:
Hepatitis C virus (HCV) infection is the leading cause of endstage liver disease in Western and Asian countries. However, after liver transplantation, HCV recurs in virtually all patients, and estimated HCV-related graft cirrhosis at 5-year follow-up is 30%. Although immunosuppression accounts for a major part of the accelerated progression of HCV in the transplant population, the best immunosuppression for recipients with HCV that could avoid such complication remains unknown at present. Combination therapy of interferon and ribavirin is thought to be the most effective for the treatment or prophylaxis of HCV infection. However, who should be treated, when treatment should be initiated, and with what agent should patients with HCV infection be treated are still unknown. The current data on HCV recurrence in patients who have received either living- or deceased-donor liver transplantation are controversial, but they are, presumably, similar. Thus, to avoid HCV recurrence in living-donor liver transplantation, we have to take approaches similar to those used for patients receiving deceased-donor liver transplantation. Based on reports from major transplant centers around the world, we consider the best strategy for liver transplantation-related HCV infection is steroid-free immunosuppression and preemptive low-dose interferon and ribavirin combination therapy. Here we describe our experience with living-donor liver transplantion for patients with hepatitis C at Osaka University. There is a need for standardizing the treatment for HCV infection. This can only be achieved through collaborative work between various liver transplant centers worldwide.
