Management of Recurrent Hepatitis C Following Liver Transplantation: Hepatitis C and the Transplanted Liver

Recurrence of Chronic Infection

Recurrence of hepatitis C viremia following liver trans­plantation occurs in all patients with chronic HCV infec­tion who have detectable serum HCV RNA levels prior to transplant. A significant decline in serum HCV RNA levels has been observed during the anhepatic phase of transplantation and immediately following reperfusion of the allograft; however, this decline is followed by a rapid increase in HCV RNA levels within hours, and pretrans- plantation serum HCV RNA levels can be reached within days. A progressive rise in HCV RNA levels has been described over several weeks following transplantation, resulting in a new baseline viral load that is typically greater than the viral load prior to transplant.

Acute hepatitis associated with recurrent HCV infec­tion can be seen in over one half of patients, typically within the first 6 months of transplant. This finding may be associated with an acute rise in serum aminotransferase levels, increased viral load, and histologic evidence of acute hepatitis C infection with features such as lobular hepatitis, the presence of acidophil bodies, macrovesicular steatosis, and focal hepatocellular necrosis. Up to 30% of patients may subsequently develop chronic hepatitis with a variable clinical course, characterized by progressive fibrosis leading to cirrhosis within 5 years. The development of cirrho­sis in the setting of recurrent HCV infection following transplant is associated with an accelerated course and has a significant impact on survival. Clinical decompensation may occur in over 40% of patients with allograft cirrhosis within 1 year, at which time 1-year survival may decrease to as low as 40%. eriacta 100 mg

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