Management of Recurrent Hepatitis C Infection after Liver Transplantation

Chronic hepatitis C virus (HCV) infection affects approximately 3% of the world’s population, with cirrhosis caused by chronic HCV the most frequent indication for liver transplantation (LT) in the United States and Europe. 1 Between 1999 and 2007, 37% to 41% of all recipients of LT in the United States had chronic HCV. 2 However, survival of LT recipients with chronic HCV remains lower than that of recipients without HCV. This decreased survival is related to the near-universal recurrence of HCV after transplantation as well as the accelerated course of recurrent HCV after LT. 3 Between 25% and 30% of LT recipients with HCV develop graft cirrhosis, with a median time to recurrent cirrhosis of 8 to 10 years. 4,5 The clinical outcomes of these patients, and the likelihood of graft cirrhosis, are affected by multiple factors, including donor demographics, recipient virological status, posttransplant immunosuppression, and antiviral therapy. This article reviews the natural history and management of HCV following LT.