Key Points

  • 1
    Liver failure and liver cancer from chronic hepatitis C are the most common indications for liver transplantation and numbers of both are projected to double over the next 20 years.
  • 2
    Recurrent hepatitis C infection of the allograft is universal and immediate following liver transplantation and associated with accelerated progression to cirrhosis, graft loss and death.
  • 3
    Graft and patient survival is reduced in liver transplant recipients with recurrent HCV infection compared to HCV-negative recipients.
  • 4
    The natural history of chronic hepatitis C is accelerated following liver transplantation compared C, with 20% progressing to cirrhosis by 5 years. However, the rate of fibrosis progression is not uniform and may increase over time.
  • 5
    The rates of progression from cirrhosis to decompensation and from decompensation to death are also accelerated following liver transplantation.
  • 6
    Multiple host, donor and viral factors are associated with rapid fibrosis progression and HCV-related graft failure.
  • 7
    Over the last decade, graft and patient survival rates have improved following liver transplantation for non-HCV disease but not for HCV-cirrhosis. This may reflect worsening donor quality and changes in immunosuppression strategies over recent years.
  • 8
    Viral eradication by antiviral therapy prevents disease progression and improves survival.
  • 9
    The severity of recurrent hepatitis C at one year post-transplant predicts subsequent progression to cirrhosis. Annual protocol biopsies are recommended to help determine need for antiviral therapy.
  • 10
    The projected impact of recurrent hepatitis C on graft and patient survival can only be avoided by the development of safe and effective antiviral strategies which can both prevent initial graft infection and eradicate established hepatitis C recurrence.

Liver Transpl 14:S36–S44, 2008. © 2008 AASLD.