Peritransplant management of chronic hepatitis C

Hepatitis C infection is the commonest cause of cirrhosis worldwide. Management of chronic hepatitis C in peritransplant period is challenging. Patients with compensated/ Child class A cirrhosis due to HCV infection are treated like non-cirrhotics, with PEG IFN and Ribavirin, albeit with a higher incidence of complications. Treatment is not recommended for decompensated cirrhotics due to higher complication rate including risk of death. After liver transplant, immunosuppression should be adjusted to prevent/delay recurrent HCV disease. Incidence and severity of recurrent HCV disease as well as patient and graft survival is similar between living donor and deceased donor liver transplants. It is currently recommended to treat established recurrent hepatitis C i.e. raised ALT with HAI > 4 and/or F > 1. Pre-emptive/prophylactic antiviral therapy is poorly tolerated and has low efficacy. Standard dose regimen (PEG IFN 1.5 mcg/kg or 180 mcg weekly + Ribavirin 800-1200 mg/ day) for 48 weeks irrespective of genotype is the recommended treatment protocol. Therapy poses significant problems in the form of anemia, neutropenia, and a higher risk of rejection.