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Updated: May 16, 2026
Heterotopic Auxiliary Rat Liver Transplantation With Flow-regulated Portal Vein Arterialization in Acute Hepatic Failure
Published on: September 13, 2014
Liver transplantation in the setting of chronic HCV
1University of California San Francisco, United States. norah.terrault@ucsf.edu
Insights
Hepatitis C Virus (HCV) recurrence post-liver transplant (LT) leads to graft loss. Eradicating HCV before LT or achieving sustained viral response (SVR) after LT improves graft survival.
Area of Science:
- Hepatology
- Transplant Surgery
- Virology
Background:
- Recurrent Hepatitis C Virus (HCV) infection is a primary cause of graft loss and mortality in liver transplant (LT) recipients.
- Modifiable risk factors for severe HCV recurrence include donor age, cold ischemia time, prior rejection, CMV hepatitis, IL28B genotype, and post-LT insulin resistance.
Purpose of the Study:
- To review strategies for preventing and managing recurrent HCV disease after liver transplantation.
- To evaluate the efficacy and tolerability of antiviral therapies in LT recipients.
Main Methods:
- Literature review of studies on HCV recurrence, risk factors, and treatment outcomes in liver transplant patients.
- Analysis of pre- and post-transplant treatment strategies, including interferon-based and direct-acting antiviral therapies.
Main Results:
- Pre-transplant HCV eradication is the most effective prevention strategy.
- Post-transplant treatment is indicated for significant histologic severity, with sustained viral response (SVR) improving graft survival.
- Current therapies (peginterferon/ribavirin) achieve SVR in ~30% of patients, with limitations in tolerability.
Conclusions:
- Optimizing pre-transplant HCV control and post-transplant treatment strategies are crucial for improving outcomes in LT recipients.
- Emerging combination therapies show promise for increased efficacy but require careful management of adverse effects and drug interactions.
Abstract:
Recurrent HCV disease is the most common cause of graft loss and patient mortality in HCV-infected liver transplant (LT) recipients. Risk factors for more severe recurrence that are potentially modifiable are older donor age, prolonged cold ischaemia time, prior treated acute rejection, CMV hepatitis, IL28B donor genotype, and post-LT insulin resistance. The most effective means of preventing HCV recurrence is eradicating HCV prior to LT. Select wait-list candidates with compensated or mildly decompensated disease can be considered for antiviral treatment with peginterferon, ribavirin (and protease inhibitor if genotype 1). For the majority of LT patients, HCV treatment must be delayed until post-transplant. Treatment is generally undertaken if histologic severity reaches grade 3 or 4 necroinflammation or stage ≥2 fibrosis, or if cholestatic hepatitis. Achievement of sustained viral response (SVR) post-LT is associated with stabilization of fibrosis and improved graft survival. SVR is attained in ~30% of patients treated with peginterferon and ribavirin. Poor tolerability of therapy is a limitation. Combination therapy with telaprevir or boceprevir added to peginterferon and ribavirin is anticipated to increase efficacy but with higher rates of adverse effects and challenges in managing drug-drug interactions between the protease inhibitors and calcineurin inhibitors/sirolimus.
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