Hepatitis C virus (HCV) is the most common chronic blood-borne infection in the United States, affecting over 4 million individuals, with a prevalence of approximately 1.6%. Recent reports have suggested that up to two thirds of newly diagnosed chronic liver disease in the United States results from HCV. Most individuals exposed to HCV during adulthood develop chronic infection, and up to 20% may progress to end- stage liver disease. Consequently, chronic HCV infection has become a major source of liver-related mortality. The prevalence of HCV-associated advanced liver disease is expected to rise over the next several decades. HCV is currently the most frequent indication for liver transplantation, comprising approximately 40-50% of all cases.
As recurrence of HCV occurs in all liver transplant recipients who demonstrate hepatitis C viremia at the time of transplantation, the potential for progressive disease in the transplanted liver is a major concern. Although an improvement in patient and allograft survival has been described recently, in contrast to previous reports, the presence of HCV infection remains an independent risk factor for increased mortality following liver transplantation. Recipient, donor, and viral factors, as well as immunosuppressive therapies, may contribute significantly to the severity of liver disease associated with recurrent HCV. In order to achieve the goal of optimal patient and allograft survival in patients with HCV undergoing liver transplantation, several strategies have emerged, including donor selection, close histologic monitoring, interferon (IFN)-based therapy, and steroid-sparing immunosuppression.