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