Management of Recurrent Hepatitis C Following Liver Transplantation: Summary

Recurrent HCV is a major cause of allograft loss and mortality in liver transplant recipients with chronic HCV infection. The development of strategies designed to optimize patient and graft survival in this population is critical, as HCV is currently the most common indica­tion for liver transplantation. A greater understanding of the risk factors for progressive disease and vigilant post- transplant monitoring through histologic assessment may guide management aimed toward reducing the potential for graft failure as well as helping identify candidates for antiviral therapy. As treatment with PegIFN and RBV may not be possible in many patients awaiting liver trans­plantation, post-transplant antiviral therapy is a consid­eration in select individuals; however, major limitations of both preemptive and recurrence-based therapy include poor tolerability and decreased efficacy. The emergence of DAA agents targeted specifically against HCV may ultimately have a major impact on the ability to achieve viral eradication both before and after transplantation. Likewise, increasing recognition and avoidance of post- transplant metabolic complications as well as the devel­opment of novel immunosuppression strategies, includ­ing the use of steroid-sparing agents, may potentially improve long-term outcomes in transplant recipients with chronic HCV. sildenafil 20 mg

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