Abstract
Decompensated cirrhosis from hepatitis C virus (HCV) genotype 1 is the leading indication for liver transplantation in the United States, accounting for nearly 50% of all liver transplants. Recurrent HCV is universal after liver transplantation in patients viremic at the time of transplantation and leads to cirrhosis in up to 30% of patients by five years. Once cirrhosis develops, the risk of hepatic decompensation is 42% per year. This has led to recurrent HCV emerging as an important yet controversial indication for liver retransplantation and a renewed interest in the role of anti-viral therapies. Since the first report of interferon for recurrent HCV treatment in 1996, there have been several reports in the literature of interferon-based therapies for this silent epidemic. However, these studies are limited by a paucity of randomized controlled trials. Despite encouraging results with pegylated interferon and ribavirin in the non-transplant HCV population, these findings have not translated to transplant recipients where viral eradication is frequently unsuccessful ( < 40%). Although stimulating factors are often used to treat the side effects of anti-viral therapy, they are expensive and their use remains controversial. Rejection due to anti-viral therapy, although rare, continues to be a significant concern. Despite successful HCV eradication in a small percentage of patients, progressive cryptogenic fibrosis can still develop leading to hepatic decompensation requiring retransplantation. The lack of effective therapies, severe side effects and reports of hepatic decompensation despite HCV eradication raises the question of whether recurrent HCV genotype 1 should be treated with interferon-based therapies. Clinical trials of newer antiviral medications are urgently required in these patients who are at risk of rapid development of cirrhosis.
Keywords: Recurrent hepatitis c, transplantation, antiviral therapy, retransplantation, cirrhosis, hepatitis C virus, liver transplantation, pegylated interferon, ribavirin, cryptogenic fibrosis, ascites, encephalopathy, allograft, viremic, cytomegalovirus, ischemia, immunohistochemistry, councilman, hematoxylin, eosin, Immunosuppression, Corticosteroids, cyclosporine, tacrolimus, Calcineurin Inhibitors, cyclophilin-inhibitor, Azathioprine, Mycophenolate Mofetil, flaviviruses, Rapamycin, T-cell, alemtuzumab, antithymocyte globulin, interleukin-2 Receptor, daclizumab, basiliximab, Viral Genomic Heterogeneity, Quasispecies, Perioperative Factors, prophylaxis, Human Immunodeficiency Virus, Interferon Therapy, leucopenia, thrombocytopenia, granulocyte-colony, Alloimmune, hepatocellular carcinoma
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