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Approach to recurrent hepatitis C following liver transplantation
1Transplant Center CH-10, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA. charlton.michael@mayo.edu
Insights
Hepatitis C virus (HCV) recurrence after liver transplant affects 50% of patients, with 10% experiencing graft failure. Early treatment of recurrence with pegylated interferon is recommended to improve outcomes.
Area of Science:
- Hepatology
- Transplant Immunology
- Virology
Background:
- Hepatitis C-associated liver failure is a primary reason for liver transplantation.
- Hepatitis C virus (HCV) recurrence post-transplant is common, affecting ~50% of recipients within a year.
- HCV recurrence can lead to significant graft loss and mortality.
Purpose of the Study:
- To review the management of Hepatitis C virus (HCV) in liver transplant recipients.
- To analyze factors influencing HCV recurrence and outcomes post-liver transplantation.
- To discuss treatment strategies for HCV recurrence and rejection in transplant patients.
Main Methods:
- Review of existing literature on HCV in liver transplant recipients.
- Analysis of factors affecting recurrence, mortality, and graft survival.
- Evaluation of treatment options for acute cellular rejection and HCV recurrence.
Main Results:
- Higher corticosteroid exposure correlates with increased mortality and severe HCV recurrence.
- Treatment of acute cellular rejection in HCV-infected recipients is linked to poorer patient survival.
- Steroid-resistant rejection significantly increases mortality risk in HCV-infected liver transplant recipients.
- Pegylated interferon with or without ribavirin is suggested for histologically apparent recurrence before bilirubin exceeds 3 mg/dL.
Conclusions:
- Management of HCV post-liver transplant requires careful consideration of immunosuppression and rejection treatment.
- Early intervention for HCV recurrence, particularly with interferon-based therapies, is crucial.
- Further research into novel immunosuppressive agents and immunoglobulin therapy is needed for HCV management after transplantation.
Abstract:
Hepatitis C-associated liver failure is the most common indication for liver transplantation. Histologic evidence of recurrence is apparent in approximately 50% of hepatitis C virus (HCV)-infected recipients in the first postoperative year. Approximately 10% of HCV-infected recipients will die or lose their allograft due to hepatitis C-associated allograft failure. HCV-infected recipients who undergo retransplantation have 5-year patient and graft survival rates that are broadly similar to those for transplant recipients who are not HCV infected. Although the choice of calcineurin inhibitor, mycophenolate mofetil, or both has not been clearly shown to affect histologic recurrence of hepatitis C, higher cumulative exposure to corticosteroids is associated with increased mortality and more severe histologic recurrence. In contrast to treatment of non-HCV-infected recipients, treatment of HCV-infected transplant recipients for acute cellular rejection is associated with attenuated patient survival. Steroid-resistant rejection with or without the use of T-cell-depleting therapies is associated with a greater than fivefold increased risk of mortality in HCV-infected liver transplant recipients. Pegylated interferon with or without ribavirin should be considered for treatment of recipients with histologically apparent recurrence of hepatitis C before total bilirubin exceeds 3 mg/dL. The role of hepatitis C immunoglobulin and new immunosuppressive agents in the management of hepatitis C after transplant continues to evolve.
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