[Recurrent disease after liver transplantation. A therapeutic dilemma or treatable?]

Side effects of immunosuppressive drugs, the development of de novo malignancies and disease relapse determine the prognosis of liver transplant patients in the long-term course.

Treatment of carefully selected and monitored hepatitis C liver transplant patients with interferon-alpha and ribavirin is safe but less efficacious as compared to the non-transplant setting. Postoperative hepatitis B hyperimmune globulin and nucleoside analog combination therapy has resulted in a decrease of reinfection rates to < 10%. New molecular techniques as well as genotyping of hepatocellular carcinoma gain increasing importance for estimation of recurrence-free survival. Diagnosis of disease relapse in cholestatic and autoimmune liver disease is more challenging than in the non-transplant setting and therapeutic options are limited. Psychiatric evaluation and careful validation of compliance are important issues for estimation of the risk of disease recurrence in patients with alcohol-related liver disease. During long-term course, up to one half of patients die of transplant-related causes; 30-70% of these cases are attributed to relapse of primary disease.

Further improvement of strategies for prevention and treatment of recurrent disease after liver transplantation is warranted in order to increase long-term survival.