Published online Aug 21, 2014. doi: 10.3748/wjg.v20.i31.10668
Revised: January 25, 2014
Accepted: April 2, 2014
Published online: August 21, 2014
End stage liver disease from hepatitis C is the most common indication for liver transplantation in many parts of the world accounting for up to 40% of liver transplants. Antiviral therapy either before or after liver transplantation is challenging due to side effects and lower efficacy in patients with cirrhosis and liver transplant recipients, as well as from drug interactions with immunosuppressants. Factors that may affect recurrent hepatitis C include donor age, immunosuppression, IL28B genotype, cytomegalovirus infection, and metabolic syndrome. Older donor age has persistently been shown to have the greatest impact on recurrent hepatitis C. After liver transplantation, distinguishing recurrent hepatitis C from acute cellular rejection may be difficult, although the development of molecular markers may help in making the correct diagnosis. The advent of interferon free regimens with direct acting antiviral agents that include NS3/4A protease inhibitors, NS5B polymerase inhibitors and NS5A inhibitors holds great promise in improving outcomes for liver transplant candidates and recipients.
Core tip: Recurrent hepatitis C impacts graft and patient survival following liver transplant. Preventing aggressive hepatitis C virus (HCV) recurrence by selecting appropriate donor allografts for HCV patients and careful management of immunosuppression in the post-transplant setting remain crucial. Direct acting antiviral therapy in patients awaiting transplant may prevent HCV re-infection post-transplant and has the potential to fundamentally change the natural history of hepatitis C in liver transplant recipients.