Management of Recurrent HCV and HBV Infections after Liver Transplantation

Sequels of chronic HCV infection such as end-stage liver cirrhosis and hepatocellular carcinoma (HCC) are the leading indications for liver transplantation (LT) in Europe and in the United States. According to the United Network for Organ Sharing (UNOS) database the proportion of transplants performed due to the decompensated cirrhosis secondary to hepatitis C infection slightly declined in the last few years from 34% in 2002 to 29% in 2007, but at the same time the increased number of candidates for LT with HCC was noted [www.unos.org]. This trend will be observed until year 2030. Generally, one third of LTs worldwide is performed in HCV-positive patients. Given that recurrence of HCV infection is almost universal and the natural history of HCV hepatitis in allograft is more rapid than in the immunocompetent patient, liver failure secondary to recurrent HCV infection has a significant impact on post-transplant survival and will soon become the most common cause of liver retransplantation. Organ shortage and increasing evidence of poorer outcome in retransplanted patients makes this procedure a controversial issue, not accepted in many centers. Therefore efforts of transplant physicians to manage recurrent HCV infection in order to optimize outcomes and to slow down the progression of HCV-related liver disease are the greatest challenge. Most widely explored areas of interest include timing and schedule of antiviral treatment, immunosuppression regimens and matching in donor and recipient-related factors influencing outcomes.