Liver transplantation as a model to study hepatitis C virus infection

Hepatitis C virus-associated end-stage liver disease is a leading diagnosis in patients undergoing liver transplantation, accounting for approx 25% of patients transplanted at major medical centers in the United States, and for 5-15% of those transplanted worldwide (1). Although HCV infection in the early posttransplantation period usually results in indolent disease, the full clinical consequences may not be seen for five or more years after transplantation, when progressive liver failure and even hepatocellular carcinoma can develop. Orthotopic liver transplantation (OLT) provides a unique opportunity to study HCV infection for the following reasons: 1. The exact timing of infection is known (shortly after liver transplantation). 2. Possible source(s) of infection can be identified (pretransplantation infection and/or infection from the organ donor or from blood products transfused in the perioperative period). 3. Serial serum samples are often available, since these patients are typically followed in a single center. 4. Multiple liver biopsies are typically performed, which facilitates study of the histological evolution of HCV-associated liver disease.