Recurrent Hepatitis C After Liver Transplantation

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. 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 for genotype 1 patients (<40%). Rejection although rare, remains a concern and the use of stimulating factors controversial. The lack of effective therapies, severe side effects and reports of hepatic decompensation despite HCV eradication raises the question of whether these patients should be treated with interferon-based therapies. Clinical trials of newer antivirals are urgently required in these patients who are at risk of rapid development of cirrhosis.