Treatment of hepatitis B and C after liver transplantation. Part 2, hepatitis C

Authors

  • Bruno Roche,

    1. Centre Hepatobiliaire, UPRES 3541, EPI 99-41, Universite Paris-Sud, Hôpital Paul Brousse, 14 Ave. P.V. Couturier, 94800 Villejuif, France
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  • Didier Samuel

    Corresponding author
    1. Centre Hepatobiliaire, UPRES 3541, EPI 99-41, Universite Paris-Sud, Hôpital Paul Brousse, 14 Ave. P.V. Couturier, 94800 Villejuif, France
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E-mail: didier.samuel@pbr.ap-hop-aris.fr Tel.: +33-1-4559-3331 Fax: +33-1-4559-3857

Abstract

Abstract End-stage liver disease caused by the hepatitis C virus is a major indication for liver transplantation. However, recurrence of hepatitis in the graft is a major issue. HCV re-infection after transplantation is almost constant, and recent data confirm that it significantly impairs patient and graft survival. Factors that may influence disease severity and consequent progression of HCV graft injury remain unclear. Chronic HCV infection develops in 60%–80% of patients, and 6%–28% ultimately progress to cirrhosis within 5 years. Pre-transplantation antiviral treatment is not easily related to poor tolerance. Attempts to administer prophylactic post-transplantation antiviral treatment are under evaluation but are limited by antiviral drug side effects. Treatment of established graft lesions with interferon or ribavirin as single agents has been disappointing. Combination therapy gave promising results, with sustained virological response in 25% of patients, but indications, modality and duration of treatment should be assessed.

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